By: Victor Lee
The Office of the National Coordinator for Health Information Technology (ONC) recently released its 2020-2025 Federal Health IT Strategic Plan. Similar to corporate strategic plans, the Federal Health IT Strategic Plan is accompanied by a mission, vision, and corresponding objectives. Let’s review them briefly.
The federal health IT mission is to “improve the health and well-being of individuals and communities using technology and health information that is accessible when and where it matters most.” This means that health information technology systems must support a patient’s entire health journey across acute care, primary care, and wellness when people are not within the confines of a healthcare organization.
The federal health IT vision is “a health system that uses information to engage individuals, lower costs, deliver high quality care, and improve individual and population health.” This speaks to the outcomes that our nation would like to achieve and are essentially our triple aim.
A strategy flows from one’s mission and vision, and ONC articulated its strategic plan by describing 4 key goals:
Figure 1: 2020-2025 Federal Health IT Strategic Plan Goals
If this strategic plan sounds eerily familiar to you, perhaps it is because you had seen its predecessor, the 2015-2020 Federal Health IT Strategic Plan. While these two 5-year plans bear resemblance to one another, and the mission and vision are essentially the same, there are some key differences in the goals which I’ll highlight. First, let’s take a look at the 2015-2020 goals:
Figure 2: 2015-2020 Federal Health IT Strategic Plan Goals
Under Goal 1, we see a shift from person-centered health management and empowerment in the former strategic plan to wellness in the current plan. The main difference to me is that wellness spans a person’s determinants of health outside the proverbial walls of healthcare. I believe that the ONC proposed rules related to the support of standard APIs will enable individuals to support their own health and wellness through a variety of apps as well as to enable healthcare organizations to gain population-level insights on high- and emerging-risk patients.
There is a new objective in Goal 2 to reduce regulatory and administrative burden on providers. We have already begun to witness some activity toward this goal through the promotion of health IT usability and simplification of clinical documentation and EHR/public health reporting. These efforts are done in coordination between the ONC and CMS.
For Goal 3, the new objective to “advance individual- and population-level transfer of health data” speaks directly to the need for interoperable health data. ONC goes on to say that we need to “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.” While we have focused a lot on structural interoperability (e.g., FHIR, C-CDA, HL7 V2) in recent years, ONC is now emphasizing the need for better semantic interoperability (i.e., the meaning of the data within its container, as typically expressed through standard terminologies). While structural and semantic interoperability exist, they need to be better synchronized to enable us to share and make use of interoperable health data and to achieve a data-driven health ecosystem. Many recommendations to move us toward this goal are outlined in a presentation and report by the ONC Interoperability Standards Priorities Task Force.
The main difference in Goal 4 is the establishment of transparent expectations for data sharing. This speaks directly to the Trusted Exchange Framework and Common Agreement which was specifically called for by the 21st Century Cures Act and which we’ve recently summarized.
In conclusion, we’ve made a lot of progress in the last 5 years. We are now generating vast amounts of health data due to EHR adoption and various patient-generated health data sources. Our immediate challenge is to ensure that these volumes of data are of high quality, meaning that they need to be standardized, normalized, and semantically preserved when shared across health IT systems. Having achieved this, we can leverage this data to inform analytics, research, and clinical care while optimizing the experience of health IT solutions for patients and providers. The progress that we make in the next 5 years will be driven by regulatory activities (stay tuned for the ONC final rule), legislative activities (e.g., unique patient identifiers), and grassroots implementation and refinement of standards. It will surely be an exciting journey ahead, and we hope to see you along the way.