Earlier this month (January 15), the U.S. Department of Health and Human Services (HHS) released the draft 2020-2025 Federal Health IT Strategic Plan for public comment.
The Strategic Plan is intended to guide federal health information technology activities, and its goals are outcomes-driven, focused on leveraging health IT to empower patients, lower costs, deliver high-quality care, and improve health for individuals, families, and communities.
Plan Goals, Objectives and Strategies
There are four stated goals of the Health IT Strategic Plan. Each is followed by stated objectives to achieve that goal, and then specific strategies are delineated in order to meet the stated objectives.
In general, many common themes permeate the strategic plan, including the concepts of data sharing, interoperability, data consolidation and analysis, machine learning (ML), real time use of data, and privacy and security. Not surprisingly, these are also themes that permeated the 21st Century Cures Act and other recent legislative efforts. In this blog, we’ll attempt to “read between the lines” a bit, and speculate on potential future directions for HHS, ONC and CMS based on the language of the strategic plan. Consequently, following each section, we’ll offer insights into what we feel those next steps may be, and offer our opinion in these italicized, blue comment sections.
1) Promote Health and Wellness
Objective 1a: Improve individual access to health information
Enable individuals to access their health information by ensuring that they are able to view and interact with their data via secure mobile apps, patient portals and other tools.
Promote greater portability of health information through APIs and other interoperable health IT that permits individuals to readily send and receive their data across various platforms.
Improve access to smartphones and other technologies needed to attain and use health information, especially for at-risk, minority, rural, disabled and tribal populations.
Build the evidence base on the use of health information, including on the types of information that will benefit individuals most and the best ways to present information to patients and caregivers.
Provide resources on how to access and use health information so patients and caregivers understand how to use their data safely, securely and effectively.
Objective 1b: Advance healthy and safe practices through health IT
Promote healthy behaviors and self-management through patient-facing apps and wearable technology to allow individuals to track physical activity, share and compare health and fitness data, adhere to care plans, and make informed lifestyle choices.
Leverage all levels of data (e.g., individual- and community-level) to predict epidemics, inform and monitor public health action outcomes, improve quality of life, and address disease occurrence and preventable deaths.
Advance use of evidence-based digital therapeutics as treatment options for patients to prevent, manage, and treat conditions through smartphones, tablets, and other personal devices.
Objective 1c: Integrate health and human services information
Strengthen communities’ health IT infrastructure by facilitating bi-directional, secure exchange of data across healthcare and human services settings to improve care and effectively administer social programs.
Foster greater understanding of how to use health IT to assess and address unmet health and social needs for individuals and communities, and available health IT solutions that can be utilized for improvement.
Capture and integrate social determinants of health data into EHRs to assist in care processes, such as clinical decision support and referrals, integration of medical and social care, and address health disparities in a manner that is ethical and consistent with routine patient care.
Summary and Speculation: This section focuses on promoting health and wellness, and looks to encourage smartphones, wearables, and other devices as the likely interfaces for patient health IT, especially in rural and underserved settings. There is also an emphasis on exchange of information, including bi-directional exchange via apps and devices.
Currently, EHRs are only required to provide “read” access to information using APIs, yet it seems clear that future certification standards are likely to require “write” access via APIs to enable to third-party developers to directly store data into EHRs. Also, look for new ONC certification criteria to require EHRs to be able to accept data generated by wearables (such as fitness trackers) directly into the EHR.
There is also discussion regarding the importance of social determinants of care. Look for new standards requiring the capture of social determinants in future certification criteria, perhaps as part of (or additions to) revisions to the USCDI (US Core Data for Interoperability).
Additionally, look for continued support for rural and underserved populations, potentially including subsidies for purchase of devices and/or improved broadband access.
2) Enhance the Delivery and Experience of Care
Objective 2a: Ensure safe and high-quality care through the use of health IT
Optimize care delivery by applying advanced capabilities like machine learning, evidence-based clinical decision support, and smart dashboards and alerts.
Expand care beyond traditional clinical settings by expanding access to remote monitoring, telehealth, and other mobile and health IT services that can supplement clinical care.
Continue efforts to establish identity solutions that improve patient matching across data systems.
Support expanded use of health IT for promoting safer clinical practices by automating patient safety and rapid-reporting features into the health IT infrastructure to prevent and address adverse events, including overprescribing of controlled substances.
Use electronic clinical quality measure (eCQM) data to optimize healthcare providers’ and researchers’ abilities to assess quality and outcomes.
Implement mechanisms of data governance and provenance to promote safety, security, and accountability through all stages of care and uses of health IT.
Promote interoperability and data sharing through widely accepted standards to ensure health information is freely available across care settings for patient care, public health, research, and emergency and disaster preparedness, response, and recovery.
Customize care through precision medicine to assist in the diagnosis of disease and targeting of treatment to individual patients through the use of data in real time.
Objective 2b: Foster competition, transparency and affordability in healthcare
Encourage pro-competitive business practices that allow individuals to easily use and choose from multiple validated health apps and other health IT tools without special effort.
Support efforts to merge administrative and clinical data streams to have real-time financial data at the point of care.
Make care quality and price information available to individuals in an accessible, easily understandable format.
Educate consumers on the availability of quality and price information and how to use this information to shop for care based on value.
Objective 2c: Reduce regulatory and administrative burden on providers
Simplify and streamline documentation required of healthcare providers at the point of care when using health IT while ensuring that quality standards are upheld.
Promote the use of evidence-based automated tools to streamline provider workflows, encourage electronic provider-to-provider data exchange and improve efficiency.
Monitor the impact of health IT on provider workflows to better understand and optimize the use of technology in ways that minimize unnecessary steps or negative outcomes for patients.
Promote greater understanding of applicable regulations and practices by providing guidance and other tools to healthcare providers and health IT developers so compliance is achieved efficiently.
Harmonize provider data collection and reporting requirements across federal agencies.
Objective 2d: Enable efficient management of resources and a workforce confidently using health IT
Streamline processes to reduce the effort required by healthcare providers and health systems to generate, input and share health information.
Implement education and training programs to educate and build a strong, cross-functional health IT workforce that can support IT across healthcare settings, especially in rural areas.
Continue to invest in the federal health IT workforce by allocating more resources to train, recruit, and retain workers and to support adequate job opportunities.
Summary and Speculation: Focusing on the delivery and experience of care, goal two looks to improve patient choice in determining the most appropriate direction for care, as well as reducing burden for providers, allowing them to focus more on patients than on EHR data entry.
Look for support for predictive solutions driven by technologies such as machine learning, analytics, remote monitoring and similar solutions designed to augment direct patient care. Support for telehealth is very likely to become a future focus.
Automation and “smart systems” are emphasized, along with interoperability and data exchange, and the use of real-time data, including financial data available at the point of care (note this is consistent with recent OPPS Price Transparency Final Rule, which requires real-time access for consumers to cost-sharing information).
Look for certification requirements to continue to promote interoperability, exchange of data between systems and devices, and possibly requiring analytic solutions offering real-time care recommendations to providers, such as alerts and diagnostic and/or treatment recommendations. Real-time financial data is likely to become a future certification requirement as well.
Automation of workflows to help reduce the burden of data entry is also considered, although this might prove difficult to implement in practice. Look for future legislation to help address the shortage of healthcare IT workforce, especially in rural and underserved areas.
3) Build a Secure, Data-Driven Ecosystem to Accelerate Research and Innovation
Objective 3a: Advance individual- and population-level transfer of health data
Improve harmonization of data elements and standards by creating a common vocabulary set to improve the consistency, integrity, and quality of data and to enable data to be effectively shared between systems using APIs.
Bolster secure access to large data sets of health information for use in quality improvement and outcomes research.
Enable individuals to securely provide data via apps and other health IT for research in a manner that is consistent with individuals’ consent preferences to participate in research.
Support appropriate use of health and human services data across federal- and state-level systems to enable population health planning, analysis of quality and patient outcomes across care settings and programs, and clinical research.
Foster data governance that supports a secure, unified platform of researchers, innovators, individuals, payers, and healthcare providers to support innovative uses of shared data.
Objective 3b: Support research and analysis using health IT and data at the individual and population levels
Increase use of new technologies and analytic approaches like ML and predictive modeling to harness the power of integrated data for improving quality, outcomes and decision-making.
Build the evidence base on use of health IT for improving quality through research that investigates the impact of health technologies on patient care, safety and outcomes.
Increase research into targeted therapies through real-time data and ML intelligence, informed through public health principles, data, and research.
Identify and implement health IT opportunities that support rapid-sharing of disease surveillance data
Summary and Speculation: Focusing on data sharing, standards, and data aggregation, goal three looks to promote policies for data security, standards-based APIs and population health solutions.
Look for ONC to establish common vocabularies for data exchange, including expansion of the current USCDI data set, along with additional standards. In order to exchange data between EMRs via APIs, look for more standardization and specificity for common data definitions and data exchange protocols.
Research leveraging large data sets is also emphasized, using machine language and predictive solutions to assist with disease surveillance and other public health initiatives. Look for future rule-making supporting the streamlining of aggregation and storage of large data sets to support these initiatives.
4) Connect Healthcare and Health Data through an Interoperable Health IT Infrastructure
Objective 4a: Advance the development and use of health IT capabilities
Promote a digital economy that leverages research and development, and that can lead to the development of new business models in healthcare in a manner that protects privacy rights.
Reduce financial and regulatory barriers that are perceived to prevent new health IT developers from entering and competing in the health IT marketplace.
Promote trustworthiness of health IT through rigorous enforcement of information-blocking and privacy and security laws when applicable, and by encouraging consumer reviews and reports on health IT products.
Develop frameworks to assess patient and care team use of new technologies and build an evidence base on the utility and impact of health IT.
Support provider adoption and use of health IT by requiring health IT use to participate in federal programs, investing in health IT, and making resources available to support adoption and use.
Enable competition by reducing switching costs between EHR and other health IT products and systems.
Adopt and advance nationally endorsed standards, implementation specifications, and certification criteria through continued collaboration across public and private sectors.
Follow health IT safety and user-centered design principles in the development and design of solutions to ensure tools are safe, accessible, usable and address the needs of the users for whom they are developed.
Objective 4b: Establish transparent expectations for data sharing
Address information blocking and other actions taken by healthcare providers, health IT developers, and other regulated entities that limit the access, exchange, and use of electronic health information.
Develop resources and communications plans, including guidance for healthcare providers and other staff at healthcare organizations on how to comply with regulations.
Support a common agreement for nationwide exchange of health information that drives interoperability, supports federal agencies’ strategies and promotes effective governance.
Promote data liquidity by working with developers, healthcare providers, payers, and state and federal entities to eliminate unnecessarily restrictive data-sharing practices and to use endorsed standards, implementation specifications, and certification criteria.
Objective 4c: Enhance technology and communications and infrastructure
Assess current and expected broadband needs and gaps in the health and healthcare sectors.
Improve and expand affordable broadband access and wireless infrastructure, especially in rural and underserved areas that are less likely to have access to high speed internet.
Deploy cloud-based services that comply with federal standards to modernize and streamline the way health information is stored and exchanged across the federal government.
Promote adoption of infrastructure needed for telehealth to reach patients outside of traditional care settings.
Objective 4d: Promote secure health information that protects patient privacy
Integrate privacy and security considerations into the design and use of health IT to promote a culture of privacy and security and protect individual- and population-level data from cybersecurity attacks, fraud, misuse, and other harms.
Implement privacy and security mechanisms as appropriate to the sensitivity of the data to help protect individuals’ health data, including multi-factor authentication and encryption embedded in APIs and other technologies.
Increase patient understanding and control over their data so they can make informed decisions about data exchange and secondary uses of their data.
Provide guidance and technical assistance on policies and regulations at the federal, state, and tribal levels that pertain to the secure exchange of health information and enforce such rules.
Summary and Speculation: Goal four focuses on some of the technical aspects of information exchange and interoperability. Removing barriers to information exchange, ensuring data is trusted and information security are common themes.
Increased regulatory pressure is hinted, by requiring health IT use in order to participate in federal programs, establishment of common standards and certification criteria, and support for a Common Agreement for data exchange (likely a direct reference to TEFCA and potentially requiring its adoption – see our two-part blog series (TEFCA in a Nutshell Part 1 and Part 2 for more information on this important legislation).
Additional mention is again made regarding adding infrastructure, particularly for rural and underserved areas. Again, expect additional funding initiative to support improving services for these constituents.
Finally, data privacy and security is emphasized. Look for additional rule-making to establish security standards and common protocols that will facilitate exchange while simultaneously ensuring data security.
Note that there is more to the Health IT Strategic Plan than what is discussed here. ONC reviews its vision for how the plan will be used, serving as a “roadmap” for future federal health IT initiatives, the health principles that are an integral part of the plan, and the challenges in healthcare that are driving the direction of many of the plan’s initiatives.
Readers are encouraged to download and review the plan in its entirety, as (like the 21st Century Cures Act) the Federal Health IT Strategic Plan is likely to shape and influence the healthcare information technology landscape for the foreseeable future.