Episode 15: ONC's Steve Posnack Dishes on the Transition and the Vision for Interoperability
Our first podcast episode of 2021 features distinguished guest Steve Posnack, Deputy National Coordinator for Health Information Technology for The Office of the National Coordinator (ONC). Our new host Ken Kleinberg along with co-hosts Jocelyn Keegan and Pooja Babbrah talk with Steve about the administration transition, FHIR, moving to APIs in healthcare and the mission to achieve interoperability.
Ken first asks Steve what he expects to see from the Biden administration, more specifically, how that transition will impact ONC and Centers for Medicare & Medicaid Services (CMS) moving forward. Steve says we were set forward on a course related to the 21st Century Cures Act and there is still more to be done in implementing the statutes. Health IT has largely received bipartisan support. The technology work and how technology can be used to support healthcare to make it better is something he believes everyone is passionate about. Steve’s points echoed an expected continuity of cross-party support toward areas like health IT, health data and improving the overall functioning, effectiveness, and outcomes of our nation’s healthcare system through the use of technology. He did, however, expect to see a greater focus on pandemic response with the Biden administration.
Ken transitions to the next topic and asks Steve and our co-hosts to give their thoughts on how we will see APIs and the work of FHIR accelerators used to support the COVID response and management of the pandemic moving forward. Steve notes the event Accelerating APIs in Healthcare: A Year in Review and Momentum for 2021 that took place on December 1, 2020, which highlights the accomplishments of four years of initiatives, investments and industry participation. He sees opportunity to continue to reduce burden and automate processes as well as work to enrich the point of care through the use of technologies and tools.
Jocelyn points out that the impact of COVID, and the pandemic in general, falls into two classes when it comes to advancing APIs. We’ve seen some folks pull away from their progress toward value-based care due to delays in compliance dates. However, then we see some people who are no longer waiting on vendors and are understanding the role of APIs. There’s nothing else that could have happened to further splay open the current state we tolerate as members of the United States’ health system in terms of lack of interoperability. She says it’s not about ripping out or replacing old standards, but rather, identifying where we can leverage APIs and tools we get out of FHIR to be able to sew together all these disparate parts.
Pooja notes an important topic gaining attention during the pandemic: advanced care planning. People are ending up in the ER or getting intubated. It’s not easy for providers to get that information for people who are ending up in the hospital. These patients may have a do not resuscitate or do not intubate order in place. It’s not just the HL7 FHIR accelerators that are taking what everyone is doing around these FHIR APIs, but we’re taking that and applying it in other areas.
Ken asks Steve what other stakeholders who have not traditionally been involved in ONC’s rulemaking will be included in future efforts. Steve says ONC’s footprint is widely expansive as his office is the cross section of healthcare as a whole. The Cures Act touched on pediatrics a little bit more heavily and we’ve been putting out some resources in that regard. Long term post-acute care was another place that was ineligible for incentives under the original HITECH Act money. Then we have everything in between such as behavioral health, mental health, other types of specialty care that are trying to connect to your home base (primary care physician, hospital or ADT notifications). We want to make sure the care community serving patients is aware of what’s going on. All of this relies on data and interoperability. Steve also mentions that pharmacy efforts around electronic prior authorization and support for opioid care and management of medication are exciting areas of work as well.
An interesting topic, Ken asks Steve how industry participation helps drive ONC’s rulemaking. Steve explains that most all his office’s efforts are focused on longer-term visions to make lasting change, which means building relationships and establishing trust with stakeholders is essential. He says we can’t regulate our way out of everything, but rather, we must get everyone on board for the same mission. Steve notes the importance of seeking knowledge from industry colleagues. Pilot testing and standards performance testing are a vital part of the process, yet he finds that it is sometimes difficult to find stakeholders to back investments.
Jocelyn brings up the issue of incentivizing people so they want to become early adopters. How do we lift the ceiling for those who really want to innovate? She poses a question to Steve asking how they go about making sure that standard ceiling is lifted while at the same time making sure people are meeting the requirements of the floor. He responds by saying this is an issue they have been chipping away at for some time. It’s difficult from an interoperability perspective because if two people are at very different levels, sometimes it is okay, but other times there is a hard break resulting in friction. As long as it doesn’t create a discrepancy in interoperability, we will allow communities to move forward with standards on a voluntary basis once their other requirements are met.
To finish the podcast, Steve leaves us with an honorable mention to Project USA, something to look out for in the coming year, as well as a nod to the continuation of TEFCA and the 21st Century Cures Act in 2021.
Pooja’s final comments commend Steve for bringing up pharmacy. She notes there actually is a lot of work coming out of ONC that supports the pharmacy-side of healthcare. She advises her fellow colleagues in pharmacy to pay attention to the happenings of ONC and utilize them as a stakeholder in the coming year.
Jocelyn ends the podcast by saying she would like to see what momentum will look like on the existing proposed rules once the dust settles, especially with the delay around the information blocking rules themselves and what will the industry need to do to keep things moving forward.