New ONC Administration Outlines Priorities for the Department

In a wide-ranging call with reporters on Tuesday, the new top officials at the Office of the National Coordinator for Health IT (ONC) appointed by the Trump administration outlined their main priorities for the department—improving electronic health record (EHR) usability and helping foster improved health data and system interoperability in the US healthcare system. But while privacy and security issues will also be a priority, ONC officials said there are no plans to replace their department’s vacant Chief Privacy Officer role.

Regulatory Measures Targeted to Simplify EHR Use for Providers

As part of improving EHR usability, a main priority of ONC will be to help strip away various regulations and reporting requirements that overburden healthcare providers and take time away from patients, said Dr. Donald Rucker, National Coordinator for Health IT.

This initiative will be a main priority of Dr. John Fleming, who was recently appointed to a new role at ONC as deputy assistant secretary for health technology reform. “EHRs are more of a burden than a benefit,” Fleming said, “and providers look to us to help solve those problems.” Fleming said his function at ONC will be to work with the team on reforming EHR reporting and administrative requirements so physicians spend less time on data entry and more time taking care of patients. “Remember when commercial aircraft became more complex, pilots had systems overload and it made it very difficult to fly the plane when they had to pay attention to all of these new controls. That is going on in healthcare right now, it’s hard for a doctor to spend time and attention on patients because they are so focused on the different administrative requirements,” Fleming said. “At the end of the day we have an onion of many layers of administrative burden on healthcare providers, and they particularly impact the private independent physician to the point they have given up their practice.”

EHRs have become a symbol of physician administrative burden, Fleming said. “Those [administrative requirements] are areas that we feel as an administration we have the ability to affect. Start to unpeel the onion.”

Rucker said ONC will stop focusing on getting providers to implement EHRs, something he said has already been handled by the “meaningful use” EHR Incentive Program with no need “to further spur.” ONC’s next step is ensuring the EHRs in place work efficiently for providers and allow the interoperable exchange of health information. “The easy stuff is done, getting an EMR [EHR] and paying for it. Now we are working on interoperability and using EMRs, and that is the hard part,” Rucker said.

“At some point the expense of complying with quality measures becomes more than the actual value of the quality measure,” Rucker said. He said EHRs have been developed for documentation and billing, but not for making a doctor’s job easier. “That is a funny kind of beast. All other industries use computerization for automation and to become more efficient. We are the only industry I know that has used computerization to become less efficient.”

Use of things like open API in EHR systems would allow health IT developers to improve EHRs and make them more efficient for providers, as well as allow the massive amounts of health information being collected by EHRs to be better analyzed for improved care outcomes, Rucker said.

Exactly which EHR-based regulations Rucker and Fleming are looking to repeal were not discussed. While the Centers for Medicare and Medicaid Services is actively looking at areas where it can reduce regulations, ONC will also do its part in a similar review. “The burden comes from many different areas,” Rucker said. “I hate my computer kind of thing. It is a complex set of issues, many are innate to the architecture. We are looking at various things ONC controls, looking at the current regulations being enforced.”

Interoperability Roadmap Still Being Followed

Use of standards in interoperability will be essential for both health IT development as well as actual exchange of information. ONC’s interoperability efforts will focus on three major use cases:

  1. Allowing patients the ability to get their data
  2. Enhancing accountability and privacy/security so that health data can be securely used
  3. Fostering more open competition in health IT product development by giving developers stronger standards and more open APIs in order to develop products that make EHRs easier to use and access

Genevieve Morris, the new principal deputy national coordinator for health IT, said interoperability would be her main focus at the department. ONC will continue to advance along the Interoperability Roadmap rolled out in 2015, which Rucker described as a “solid path.” Morris noted that recent industry and regulation changes may cause the new ONC administration to create some detours to the plan along the way.

One recent regulatory initiative, the 21st Century Cures Act, calls on ONC to create a trusted exchange framework and common agreement that achieves full network to network exchange of health information. Work on that framework will begin July 24 with a series of meetings and public comment periods. A draft of the framework and common agreement will be released for public comment early next year, Morris said.

The 21st Century Cures Act also loosened regulations on discussing the potential development of a national patient identifier, which aims to improve data management and interoperability by assigning patients a unique number tied to their medical information that prevents misidentification or the creation of duplicate records. While Rucker acknowledged this is an important issue in terms of interoperability, he suggested that an actual patient identifier number might not be the sole solution. As other identifiers such as biometrics and speech recognition develops, these could be alternative identifying methods to connect patients to their specific information, he said.

No Plans to Fill Chief Privacy Officer Position; HIPAA Work Will Continue

While privacy and security issues are top of mind at ONC, Rucker said that the formal Chief Privacy Officer role in the department, vacated by Obama administration appointee Lucia Savage, who resigned in January with the change to the Trump administration, will not be filled. Rucker said that instead privacy and security work is being actively integrated into everything ONC does, meaning a formal position dedicated to this area is not necessary. “At the heart of interoperability, the first thing you think about is security. An open API is not open in that anyone can come in, you need a trust structure,” Rucker said. “There is an entire stack of privacy and security concerns at ONC; it is implicit in every single thing that we do.”

Rucker said privacy and security is top of mind when discussing the call for open APIs in health IT systems, like EHRs. “Authentication options for a healthcare provider’s system is much different than the authentication system for a vendor,” he said. “There are a lot of different strategies here, but it is really throughout the agency, this is way more important than to just leave with one person or slot.”

ONC’s work on clarifying misperceptions about HIPAA will continue, Rucker said. ONC has begun conversations with the Office for Civil Rights regarding the HIPAA law and how to “parcel out these different tasks” previously covered by the Chief Privacy Officer, which includes “figuring out how to make the whole issue of privacy and what’s covered and what’s not covered [under HIPAA] more clear.” When asked if ONC can handle all of the privacy and security issues without a dedicated office, Rucker said, “I think we already have that with the Office for Civil Rights.”


Chris Dimick ( is editor-in-chief at Journal of AHIMA.

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