Looking Forward – and Backward – to Predict Health IT Under Trump 2.0

By Tony Schueth, CEO

As the nation prepares for the upcoming presidential term, there is significant anticipation regarding the policies President-elect Trump might enact both immediately and over the course of his four years in office. We’ll leave broader predictions to others, but as a healthcare information technology (health IT) consultancy, Point-of-Care Partners (POCP) is particularly interested in the impact on health IT.

Founded in 2003, POCP has been through six presidential elections. While their priorities, tactics and investments may differ, one point on which both political parties agree is that health IT is part of the solution to the nation’s healthcare challenges.

As evidence, the Office of the National Coordinator for Health IT (ONC) was established in 2004 under a Republican administration (President George W. Bush). It was expanded and codified under the Obama administration and, earlier this year, evolved to the Assistant Secretary for Technology Policy (ASTP) under a Democratic administration (President Joe Biden).

ASTP is critical to health IT because the division promotes its adoption, helps in setting standards, supports innovation and facilitates health information exchange. It does so by convening industry leaders, setting policy and leading the industry. In the past two years, it has added coordination of artificial intelligence (AI) for the entire Department of Health and Human Services (HHS) to its list of responsibilities.

The ascension of ONC to ASTP is noteworthy because of the impact that HHS has on the country. With a 2024 budget of $1.7 trillion, it is the largest federal government agency. It oversees the Centers for Medicare and Medicaid Services (CMS), Food and Drug Administration, Centers for Disease Control and Prevention, National Institutes for Health and other agencies.

It has been pointed out that the Trump administration isn’t your average Republican administration. So, what will health IT look like under President-elect Trump? There’s a lot of speculation but, as has also been pointed out, we can look historically to Trump’s first term as an indicator of potential directions for the next one.

Trump Administration, 2016-2020

POTUS does not select the head of ASTP, the HHS Secretary does. In President-elect Trump’s first term, his initial HHS Secretary, Tom Price, MD, created a Deputy Assistant Secretary for Health Technology Reform and named John Fleming, MD, to that post. This role was part of his broader efforts to emphasize the importance of health IT and data in healthcare while advocating for reduced regulatory burden.

Dr. Price also selected Donald Rucker, MD, to serve as the National Coordinator for Health IT, and industry executive Genevieve Morris, MPA, the Principal Deputy National Coordinator for Health IT. All three political appointees worked closely with a dedicated, well-regarded team of civil servants.

A former representative from Louisiana, Dr. Fleming focused on health IT policy and regulatory issues. He wasn’t particularly high profile outside of the administration and Congress. His tenure was marked by efforts to reduce the regulatory burden on healthcare providers, particularly around meaningful use and the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA). Serving for two years from March 2017 to 2019, he worked to streamline health IT regulations to make them more manageable for practitioners, reflecting on his background as a family physician.

Dr. Rucker served until Micky Tripathi, PhD, MPP, was appointed to serve as National Coordinator for Health IT in January of 2021, the first nonphysician in that role. During Dr. Rucker’s tenure significant progress was made on interoperability and patient access with an emphasis on preventing information blocking, part of the 21st Century Cures Act, a bipartisan bill passed at the end of the Obama administration. Dr. Rucker was responsible for implementing policies that align with the landmark act, which aimed to enhance the use of health IT and improve quality of care. He also introduced bulk Fast Healthcare Interoperability Resources (FHIR) data access.

Ms. Morris’ tenure at ONC lasted little over a year. One of her significant contributions was her involvement with the Trusted Exchange Framework and Common Agreement (TEFCA). TEFCA is designed to create a standardized approach to health information exchange across the United States, ensuring that health data can be shared securely and efficiently among different healthcare organizations. Morris played a key role in developing and promoting this framework, which is crucial for achieving nationwide interoperability in health IT. She next moved to the Veterans Administration, where she served as chief health information officer responsible for overseeing the VA's initiative to transition to a new electronic health record (EHR) system. Ms. Morris is currently vice president of interoperability strategy at Optum Insights. In this role, she leads efforts to enhance interoperability of health information systems.

The current Deputy National Coordinator for Health IT, Steve Posnack, MS, MHS, was promoted to that post during Dr. Rucker’s tenure in August 2019. Exceptionally well regarded across the industry, Mr. Posnack has been with the agency 15 years.

Dr. Rucker and his staff also worked closely with other HHS agencies, perhaps the most noteworthy, CMS. The CMS administrator in the first Trump term was Seema Verma, MPH, now general manager and executive vice president at Oracle Health (formerly Cerner). During her time at CMS, Ms. Verma championed initiatives to improve interoperability and ensure patients have access to their health information. This included efforts to make EHRs more accessible and portable. She led efforts to increase price and quality transparency, allowing patients to make more informed decisions about their care, as well as an initiative to reduce regulatory burdens on healthcare providers. She also worked to accelerate the transformation to value-based care. When the pandemic hit toward the end of her term, CMS significantly expanded telehealth services to ensure continued access to care while minimizing the risk of virus transmission.

Looking Forward

On November 14, President-elect Trump nominated Robert F. Kennedy, Jr. to be Secretary of HHS. A former presidential candidate, Mr. Kennedy has been vocal on many issues – most notably vaccines and public health – but has been relatively mum on health IT.

While many of his more controversial views have nothing to do with health IT, one position he advocates is having more information about clinical studies leading to the approval of vaccines as well as potential after-effects. EHRs can provide information to the provider and health IT can get information to patient.

A growing number of vaccines are now being administered by pharmacists as their clinical role increases and they operate as part of the care team and the top of their license. One challenge, however, is pharmacy information systems have traditionally been used in the non-hospital setting to support dispensing and billing of medications and are only recently being modified to support vaccine administration and other clinical functions. With exceptions, of course, such clinical information as medication or visit history, genomics, etc., have been unavailable to pharmacists operating outside of health systems.

Another obstacle is that pharmacy billing standards come from the standards development organization National Council for Prescription Drug Programs (NCPDP), pharmacy information systems outside of the health systems are optimized for NCPDP, and the clinical transaction standards are generally based on Health Level 7 (HL7). The good news is that NCPDP and HL7 have been working together to build bridges between their systems. A new HHS leader who believes strongly in getting information to providers and patients about vaccines could accelerate these efforts.

There have been many efforts to get information to patients over the years, some more successful than others. Perhaps the most successful have been patient portals bolted onto EHRs. If the objective is to have a well-informed patient before choosing to receive a vaccine, however, the point of care and other channels may be most impactful.

Public health is perhaps the least automated component of the healthcare system. To its credit, however, the Biden administration significantly invested in modernizing and automating public health systems. A key initiative was the American Rescue Plan, a component of which allocated $1.1 billion for community health, outreach and health education workers. This funding supports deployment of over 40,000 community health workers. An additional $6 billion was invested in community health centers to expand COVID-19 vaccinations, testing and treatment, as well as to enhance their operational capacity. Outside of that plan, an additional $240 million was allocated to integrate mental health and substance use disorder treatment into primary care at more than 400 community health centers. These investments are part of a broader effort to enhance the public health infrastructure, improve access to care and address health inequities.

Of course, the HHS Secretary will appoint the ASTP, and we can only speculate on who might be candidates for such a role and what their priorities might be. If the new ASTP adopts priorities from President-elect Trump’s first term, that would be a good thing. Health IT adoption takes time. Reducing provider burden, price transparency and value-based care have evolved but still need work.

Recommendations

If we were asked by the Secretary of HHS and the ASTP for recommendations, we would start by pointing out that an administration that believes so strongly in improving efficiency should continue to support efforts to increase adoption of health IT and AI. While both have other benefits for the country – such as improving quality and enhancing care – the largest return on investment (ROI) for health IT is improved efficiency.

We would caution an administration wanting to reduce regulations to be careful of pulling those impacting health IT. Regulations in health IT encourage adoption of technology on a similar timeline. In our opinion, not having regulations around the adoption of health IT leads to inertia as innovators and early adopters benefit only marginally from other innovators and early adopters’ investments while the remainder of the industry waits. Health IT transactions are many to many, and ROI on health IT increases when the others adopt.

Identifying use cases and creating standards for health IT can take time. Significant progress has been made but we are nowhere near accomplishing our objectives. We would therefore advise continued work on efforts to enhance the secure access, use and exchange of clinical and administrative data between healthcare stakeholders, including pharmacists; adopting AI in an intelligent but careful manner; reducing administrative burden; improving price transparency and supporting value-based care.

While we can analyze past trends and policy directions to make informed predictions, the future of health IT under the next administration remains uncertain. The interplay of evolving priorities, potential regulatory changes, and technological advancements creates a dynamic landscape that requires agility and foresight. Organizations need trusted partners who can help them not only stay informed but also make strategic decisions that align with their goals in this ever-changing environment.

At POCP we understand the complexity of navigating health IT policy and industry shifts. With decades of experience and a 360-degree view of the health IT ecosystem, we are here to provide clarity and guidance. Whether it’s determining your next steps, prioritizing initiatives, or ensuring efficient resource allocation, POCP is the partner you can rely on to turn uncertainty into opportunity. Contact us to learn how we can help your organization stay ahead of the curve and confidently tackle the challenges ahead.