ONC Head Donald Rucker Offers Preview of Upcoming AHIMA Convention Keynote Address
Health information management (HIM) professionals can be assured that the new National Coordinator for Health Information Technology, Donald Rucker, MD, shares many of the same goals and frustrations that they do—including a lack of health IT and health information interoperability and growing administrative burdens.
Rucker will be a keynote speaker at this year’s AHIMA Annual Convention and Exhibit, taking place October 7 to October 11 in Los Angeles, CA. Rucker recently spoke with the Journal of AHIMA ahead of his address, and outlined his goals for the Office of the National Coordinator for Health IT (ONC).
Rucker emphasized that ONC will follow the direction set by the new Trump administration, Department of Health and Human Services (HHS) Secretary Tom Price, and Congress. One of his first priorities is ensuring ONC follows through with action directed recently passed legislation, like the 21st Century Cures Act.
“Our Secretary’s priorities match up with what we are required to do under the combination of the HITECH Act, which is the prior law, as well as the MACRA [Medicare Access and CHIP Reauthorization Act] law and most recently, the big one is the 21st Century Cures Act, which has a number of things the agency is required to do,” Rucker said.
The Cures Act, particularly the “Title IV: Delivery” section, contains a number of provisions around electronic health record (EHR) reporting systems, such as preventing health IT developers and organizations from engaging in information blocking. The work of determining just what is and is not information blocking falls to ONC, who is now collecting information on the practice. Additionally, “developers must attest that it has published application programming interfaces (APIs) to be accessible, exchanged, and used without special effort through the use of APIs or successor technologies or standards, including providing access to all data elements of a patient’s EHR to the extent permissible under applicable privacy laws,” an AHIMA analysis of the law states.
Rucker said he is encouraged by the Cures Act’s focus on developing APIs, since it is technology that could help eventually put a patient’s data on their smartphone—fostering easier use and exchange. APIs are what make banking and using maps on smartphones possible, as well as travel-related websites such as Kayak.com and TripAdvisor. They are a key to interoperable data exchange and better enable innovation.
“APIs allow comparison shopping, but there are no equivalent abilities in healthcare. [Healthcare] pricing is opaque, the services you want and the services you’ve gotten are totally opaque. So open APIs at least will open up the clinical records… You know what you’ve paid as a payer because you’ve paid a claim. But you have no idea what was provided as the patient, right—or no easy idea,” Rucker said. “You can go in and fill some custom interface and have lots of negotiations and interfaces. But you can’t electronically go in and analyze it on your own. Same problem if you’re a population health vendor, or sheer public health agencies. That’s where open APIs come in.”
Another key priority of the Cures Act and the new administration, including the Centers for Medicare and Medicaid Services (CMS), is reducing administrative burden in healthcare. Rucker noted that there’s a very delicate balance in looking at coding and documentation requirements and preventing fraud within Medicare. This gets even more complicated in MACRA, the legislation that eliminated Medicare’s sustainable growth rate, or “doc fix” reimbursement formula, with a host of bundled payment measures that attempt to move the healthcare system from paying for quality instead of quantity.
“All of the quality measures have been a challenge. How do you document these things, how do you measure them, transmit them? This is what makes this really hard… I suspect a number of [HIM professionals] have to work quite hard… It’s all work for somebody. For the provider doing the note, for the AHIMA member sitting in a medical records department, or work outsourced to some third party—somewhere it’s work,” Rucker said.
Future of HIM is Informatics, Rucker Says
A major part of Rucker’s professional background is in informatics—a major strategy AHIMA is working to promote as part of its members’ future. When Rucker was appointed, much was made of his specialty in clinical informatics, and he’s written about his experience in this field for ONC blog posts.
It’s this sort of experience that AHIMA’s members have been told repeatedly to brush up on in order to remain professionally relevant in the future. Rucker agreed, noting information and data analytics are growing areas that HIM need to move into.
“I think AHIMA members… need to learn the basics about how computers work. What’s a database, a structured query, the difference between structured and free text data, how you compute differently about structured data vs. the kinds of tools that you’d compute about free text data,” Rucker said. “I think some of the new technologies that are really burgeoning—such as natural language processing, machine learning, those types of things—that’s something I see AHIMA members needing to be a part of.”