The Office of the National Coordinator for Health IT (ONC) is facing a “pivot” stage, going from implementation of EHRs to usability and interoperability, says Karen DeSalvo, MD, MPH, MSc, the new national coordinator, speaking at the agency’s annual meeting. 

Health IT must maintain the momentum building ever since the Meaningful Use program began driving increasing levels of EHR adoption. Patient engagement is one way ONC is working toward that goal.

Patient engagement

Heath IT tools empower patients, leading to more meaningful interactions at the point of care, says Ivor Horn, MD, MPH, pediatrician and researcher at Children’s National Medical Center in Washington, D.C.

“Providers are doing more partnership building,” she says. As young patients and their families share more information, they are working together to make it actionable.

Engagement tools are ever abundant, and every day more are developed, says Ryan Bosch, MD, MBA, CMIO of Inova Health System. Patients increasingly expect data from health IT tools to be captured in the EHR, so “interoperability is just paramount.”

Innovation

Fostering innovation is another way ONC aims to maintain momentum. “Startups are trying to understand how they can help physicians, hospitals and organizations become more efficient, with an emphasis on quality of care,” says Polina Hanin, community director at StartUp Health, a global startup platform.

But their work should not take place in a vacuum. Entrepreneurs interested in health IT should shadow clinicians. “Otherwise, they will develop technology that sounds right but doesn’t actually work within the organizations,” says Hanin.

Entrepreneurs must be pragmatic about how rapidly the product will be adopted by the clinical community, says Bijan Salehizadeh, MD, managing director of NaviMed Capital, a Washington D.C.-based private capital firm. “I think it’s important for entrepreneurs to realize that things take a little bit longer in healthcare. Often, a lot longer.”

Innovators with great ideas and resources, both financial and technical, need to immerse themselves in real-world scenarios so they can truly understand where the problems are “instead of throwing out solutions and then looking for problems,” adds Jacob Reider, MD, ONC’s chief medical officer.

Salehizadeh says companies need to pay attention to what happens on Capitol Hill, calling government “the single biggest factor that can positively impact the most companies in the healthcare business.”

He anticipates that health IT innovation will really take off in a few years, when physicians and hospitals are in a better position to take risks. “We’ll reach that tipping point. By 2018, we’ll be there and that moment will be quite dramatic.”

Alignment

Aligning the requirements facing providers is another goal of ONC.

“I’ve seen the pain,” DeSalvo says. “The complexity is there. We want to make sure we do not make it so complex that it interferes with patient safety or care or the joy of practicing medicine. The laws and rules and regulations are a necessity but we want to make sure we make this convenient and realistic for everybody.”

“We’ll always have to pay attention to the value of what we’re asking people to do and make sure there is a good payoff for the patients in the end,” adds Doug Fridsma, MD, PhD, chief science officer and director of ONC’s Office of Science & Technology.

Inteoperability

Kelly Cronin, health reform coordinator, says ONC is figuring out how to accelerate interoperability and support adoption of health IT by long-term care and behavioral health providers. Also, “we want to make sure that, as accountable care organizations mature, we’re thinking critically about how we weave health IT into that. How do we advance exchange as a series of applications including those that reach patients and make sure this all fits together.”

ONC has been focused on EHR adoption for the past several years with “important investments in standards and interoperability and network services,” Cronin says. Now, the office is working on bringing the ecosystem together.

“We have made tremendous progress,” says Arien Malec, vice president of clinical solutions strategy for Relay Health, a unit of McKesson. “We have an ecosystem where two providers can send information securely.” Despite the progress, “it’s nowhere near far enough.”

Malec also says we are seeing a sea change because Meaningful Use (MU) Stage 1 raised the bar in terms of the number of providers enabled with electronic data capture. Payment system reform is starting to move healthcare away from optimizing single settings of care, he says. “We’re starting to see people clamor for data pooled for analytics and for data to be used for clinical decision support. We are going from the government pushing people to now seeing pull from the healthcare sector.”

Dave Whitlinger, executive director of the New York eHealth Collaborative, says his organization has a backlog of more than 300 providers looking to get connected to the network. “That’s with my team churning out 1.4 connections a day because this stuff is so hard to connect. Demand for HIE is growing and growing but tens of thousands of dollars to connect is ridiculous. Why are we not at plug and play?”

The numbers certainly support greater interoperability, according to Whitlinger. One of the more mature HIEs in New York did a study on more than half of the participating providers. Overall, they experienced a 30 percent reduction in redundant labs, imaging studies and avoidable ED visits. “The system pays for all the waste. The business community in Rochester said they are not going to pay for redundant services anymore.”