The American College of Physicians (ACP) applauds the Office of the National Coordinator for Health IT (ONC) on the “exceedingly thoughtful strategic plan” but notes several shortcomings.

Peter Basch, MD, chair of ACP’s Medical Informatics Committee, spoke with Clinical Innovation + Technology about the strategic plan for Federal Health IT for 2015-2020.

ONC released the final plan on Sept. 21 which reflects the input from more than 400 public comments, collaboration between federal contributors and recommendations from the Health IT Policy Committee. ONC leadership also heard from individuals, providers, community organizations and entrepreneurs from across the United States during listening sessions held in 2014.

The plan states the importance of stakeholder feedback, and explains how ONC paid close attention to come up with a better plan. “I feel that is a key message,” said Basch. “There has certainly been a strain in the relationship between ONC and providers in terms of problems with Stage 2 and concerns about Stage 3. This sets the tone of collaboration which is very much appreciated.”

The plan also extends a clear invitation to other stakeholder groups to be collaborative partners in the plan going forward, he noted. ONC makes it clear that the plan reflects its goals but realizes that it is not the strategic plan of every stakeholder. ONC is saying, however, that it wants others to help write some of the story, Basch said. ONC can’t speak for every use and specialty but it is offering “an opportunity to do the work and share in the success.” This represents an important shift, he said, and “one that I believe is welcome.”

Basch said he and ACP also appreciate that ONC acknowledged nontechnical barriers in achieving interoperability.

The association applauds the plan’s noting the importance of narrative in clinical notes. “We’re very thankful that this strategic plan states in the midst of this drive for some information to fit standard and constrained language we cannot lose sight of the importance of narrative. We thank ONC for hearing that and for calling it out.”

Lastly, this plan is revised from the draft version that positioned the learning healthcare system as a data input system. That left clinicians in the field as just data contributors, Basch said. “This plan calls out that health IT’s role is meant not just to mean a one-way feed to smart people who will tell us years later what to do differently but rather to include all of us as collaborators in the process.”

ACP noted a missed opportunity, he added. Health IT doesn’t automatically make everyone work more efficiently. The goal is to preserve patient-provider interaction time and make good, shared decisions with patients, not create duplicative documentation. Basch cited e-commerce where users often can input their shipping and payment information one time and then reuse it in the future with far less effort for a “write once use many times” situation. In healthcare, however, it’s “write many times use once.” “It’s a tremendous waste of time but it won’t get better without others at the table.”

The plan noted the goal of establishing a “responsive health IT infrastructure”—“that’s poetry to me,” said Basch—but Stage 3 currently for “forever process measures.” The regulations dictate an “inflexible, unresponsive infrastructure set by regulation not by science,” he said. “In fact, if some of what process measures call for end up not being supported by science, we’ll still have to use them.”

ACP also has an issue with the plan where it says that health IT should work in the background. When there is a potential for a provider to do something harmful, “health IT should be really obtrusive,” said Basch.  

The plan’s ending statement could be the most important, he said. Specialty and medical professional societies must step up to lead and co-own the plan to get beyond the basics.  A collaborative effort will “build a positive incremental path toward a healthcare environment where health IT stands the greatest chance of achieving its full potential.”

ACP is raising these issues as partners in the process, Basch said. This final plan is a significant improvement from the draft version. ONC “met those of us critical of the prior plan more than halfway” so he said ACP was reluctant to criticize.

“These things often are collaborative exercises,” he added. There are a lot of bright, hardworking, well-meaning people at ONC. This plan nicely expresses their desires. We’re thankful for them and for this document.”

Access ACP's letter to ONC on its website.