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December 22, 2017

2017 ONC Annual Meeting Highlights Challenges to Achieving Usability of Health Information

In his keynote speech, Dr. Donald Rucker, National Coordinator, set the tone for the two-day ONC Annual Conference in Washington, D.C. on November 30 and December 1, 2017, by noting that health information exchange is so much more than “provider to provider”.  He emphasized that the national investment in health IT requires that we get beyond this initial health information exchange “use” case.  Health information exchange must address population health; it must address patient access; it must address the need for interoperability and elimination of information blocking; and it must give patients the ability to make informed health care decisions.  For that to happen, a patient needs to be able to easily move his or her data across geographic areas and provider systems.  In short, it is the goal of ONC in 2018 to further facilitate health data exchange on a national basis.

ONC hosted public stakeholder meetings to collect information and ideas for successful health information exchange among networks.  The first kick-off meeting took place on July 24, 2017 in Washington D.C. where over 500 stakeholders shared their perspectives.  Eight entities representing “trusted exchange frameworks” (commonly called “trust frameworks”) presented, including the Strategic HIE Collaborative (“SHIEC”), of which several New York State regional health information organizations (“RHIOs”) are members. The trust frameworks shared success stories relating to their interoperability efforts.  The final public stakeholder meeting was held during the ONC Annual Conference.

Their comments related to (i) standardization; (ii) transparency; (iii) cooperation and non-discrimination; (iv) security and patient safety; (v) access; and (vi) data-driven choice. ONC anticipates the release of its formal strategy, including a draft Trusted Exchange Framework and Common Agreement (“TEFCA”), in the fall of 2018.

Dr. Rucker stressed the role of ONC in developing policy that promotes providers’ and patients’ ability to exchange health information electronically in collaboration with the health information technology industry. He boldly noted that there is now a “business case” for health IT vendors to collaborate in promoting interoperability . . . it is called the 21st Century Cures Act.

The Cures Act calls on ONC to “convene public-private and public-public partnerships to build consensus and develop or support a trusted exchange framework, including a common agreement among health information networks nationally” to provide for “full network-to-network exchange of health information.”

A common theme throughout the ONC conference was that “data hoarding”, particularly by technology vendors, will not be tolerated; vendors will need to compete on services.  Specifically, the Cures Act prohibits “information blocking” (so there is the business case for interoperability–inhibit the flow of data and risk enforcement action under the Cures Act!).  Other sections of the Cures Act address patient care improvement and empowering patient access.

Application Programming Interfaces or APIs are an important next step in advancing health information exchange use cases.  The ONC has a tutorial available which provides providers and patients alike with a basic understanding of APIs and allows users to become familiar with many of the technical terms used by developers.  Please visit their website to access the tutorial.

2018 promises to be an important year for technology development (e.g., APIs) and policy and documentation developments (e.g., the draft Trusted Exchange Framework and Common Agreement or TEFCA).  These developments will help to reduce barriers to health information exchange interoperability and advance usability, particularly as it relates to patient access and population health data analysis.

Most of the New York regional exchanges are members of SHIEC, as is the New York eHealth Collaborative, which administers the Statewide Health Information Network for New York (“SHIN-NY”).  Barclay Damon is a Strategic Business and Technology Member of SHIEC.  SHIEC continues to be an important stakeholder representative in the ONC initiatives.  For more information about our services, contact Herb Glose at, or (716) 566‑1579.

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