ONC Head Talks Interoperability, Boxer, Gingrich Debate Healthcare

For the new national coordinator for health information technology (HIT), it’s an auspicious time to be in the job. “We have created so much information in healthcare, it’s just stunning,” said Donald Rucker, MD, “and it’s not stopping.”

Rucker, a physician executive and informaticist who has also designed and built health technology, was named head of the Office of the National Coordinator for Health IT (ONC) this spring. His title is “one of the weirdest in Washington—somewhere between party planner and regulator,” he joked.

National HIT Coordinator Donald Rucker identifies MACRA and the 21st Century Cures Act as laws that have an impact on his work.

Rucker described ONC’s two areas of focus: usability of systems and interoperability.

The usability issue, he said, aims to resolve some of the “provider burdens” identified by physicians. Some of the burdens are related to documentation. “Providers don’t really like to do coding documentation—you may not have noticed,” he said. Others are related to insurance challenges such as prior authorization or quality measures that are perceived as creating more work. Rucker said the Department of Health and Human Services wants to reduce burdens and smooth regulations to produce more value. Some regulations, he said, “were put in for good reason. But it’s time for a rethink.”

Physicians and lawmakers both have been frustrated by the lack of interoperability between systems, Rucker said. “We thought we would magically get EMRs to talk to each other. There was no rabbit in the hat. Oops.” The 21st Century Cures Act, passed late last year, was an attempt to address those frustrations. It requires ONC and the Centers for Medicare and Medicaid Services to define terms such as interoperability, information blocking, and open application programming interfaces where one system talks to another.

One goal, Rucker said, is to help empower patients so that accessing medical information is as easy

In her Monday General Session speech, interim CEO Pamela Lane has a sunny prediction for AHIMA: “2018 is so bright, you’re gonna need sunglasses.”

as accessing banking or airline information on a smartphone. Other uses include making transactions with payers and other users of health data more efficient and transparent.

Technology and Fine Lines

Cybersecurity, Rucker said, is a “massive issue.” ONC is working to incorporate best practices for security into its health IT certification program, he said, but some measure of responsibility belongs to patients as well. “When patients get their data electronically, it is their data, and it is

their responsibility to protect it,” he said. “I believe the practical solution is a marketplace of companies providing help for patients [to minimize security risks].”

It is also important to navigate what Rucker called the “fine line” of privacy and security versus information blocking. “We’re trying to use modern technology as well as we can,” he said, adding that the technology can create better audit trails and accountability for information. “That will help us, but privacy comes first.”

Rucker said he looked forward to working with AHIMA on many of these issues. “It’s the folks in medical records who care about [these issues] more than my colleagues have,” he told the audience. “It’s very impactful. I have valued what you do.”

Boxer, Gingrich Offer Point/Counterpoint on Healthcare

Also on Monday, former Senator Barbara Boxer and former speaker of the US House of Representatives Newt Gingrich staked out both separate territory and common ground during a point/counterpoint session with moderator Simone Boyce. Gingrich pointed to the 21st Century

Former Senator Barbara Boxer, left, and former speaker of the House of Representatives Newt Gingrich, offer views on “repeal or replace,” electoral challenges in 2018, and the opioid epidemic.

Cures Act as an example of lawmakers of both parties working together. “Both sides were careful not to blow up the bipartisanship,” he said. The result is a law important for research, Food and Drug Administration reform, and applying science for better health, Gingrich said.

Boxer added that cooperation, as well as bipartisanship, was the key. Negotiators must be willing to give things up, she said, and represent the agreement to their own parties.

The opposite of bipartisanship is the current standoff in Congress related to the question of repealing or replacing the Affordable Care Act. “Republicans forgot that when your side is in the White House, you can pass something that may well become law,” Gingrich said. “There’s a higher standard for a law than for a political point. They were not prepared for that, and they are stymied.” He predicted that rather than repealing the law, Congress will make small modifications, and “just getting that done is a lot.”

Boxer responded that “People didn’t want [the law] repealed… People never liked it until it was threatened.” She noted that there is a current bipartisan effort at work to come up with a combination of more flexibility for states and greater certainty of stability for health insurance exchanges. “The honest way to go forward is to work with somebody,” she said.

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