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"The Dish on Health IT"
Engaging discussion around Health IT with perspectives from across the healthcare landscape. This informative and entertaining rotating panel of senior health IT consultants and their guests will keep you in the know about the latest innovations, policies and industry shifts impacting healthcare and point out the opportunities that lie within.
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Episode 10: Recap of ONC Tech Forum
On this episode of The Dish on Health IT, hosts Pooja Babbrah, Jocelyn Keegan, Ken Kleinberg and Gary Austin discuss key takeaways from the annual ONC Tech Forum. The discussion highlights key areas covered at the conference such as Fast Healthcare Interoperability Resources (FHIR), Health Information Exchanges (HIEs), United States Core Data for Interoperability (USCDI), Lab orders and results, and Social Determinants of Health (SDOH)
Gary kicks off the discussion with a baseball theme and asks everyone to give their game (conference) highlights. Jocelyn first commends the ONC team for providing a positive, interactive online experience for participants. It was the next best thing to meeting in person. As for the content, the message of the day was FHIR and the urgency to make it work. Jocelyn brings up that those who are perceived as information blocking will also start to be targeted. Ultimately, she likes the synergy happening between CMS and ONC, there is uniformity among the sessions around moving forward.
Ken’s favorite session discussed healthcare systems in other parts of the world. He says there are certain aspects of healthcare that we do exceptionally well, and there are other areas where other countries do things better. Ken also listened in on a session highlighting the challenges facing labs, especially concerning inefficiencies with the exchange of results.
Pooja observes that the overall theme of the conference seemed to reflect a pent-up consumer demand for a better healthcare system. She attended sessions she considered to be “off the beaten path,” such as long-term care. Pooja notes it’s the specialty groups that feel like what is being done today does not meet their needs. When we look at the goal of supporting value-based care, we need to be thinking about everyone on the healthcare spectrum. How do we bring those other marginalized groups into the fold as well?
Gary asks Jocelyn how fast is FHIR’s fastball. Jocelyn says it’s still too early to tell as FHIR is still maturing as a standard. However, she notes that it has been fantastic to watch real-world examples and leadership unfold in the meantime. More now than ever, it is evident as to why unleashing this data is so important. We are no longer tolerating inefficiencies like we have in the past. Jocelyn praises those on the frontlines using FHIR who come back and evangelize how they are leveraging it.
Gary asks Ken what role HIEs will play in all of this. Ken mentions that HIEs vary considerably in their success, size, and scope. Some HIEs have started to work together, which is a very good thing. There are around 100 significant HIEs in the country now, much less than just a couple years ago. They’ve had to have some sort of sustainability in who they are working with. The providers have been key in clinical data. It’s not quite clear what payer involvement looks like with HIEs. Ken says some payers claim that HIEs aren’t fully focused on their needs. He thinks that is something that will probably change. HIEs will serve both payers and providers more equally than in the past.
Pooja says HIEs can bring the longitudinal patient view. HIEs can take data from different sources and bring them together in a patient record as opposed to just bits and pieces sitting everywhere. We have the potential to reach more groups using HIEs during COVID that you couldn’t normally reach with an EHR. Pooja agrees that we are down to a smaller group of HIEs, but the ones who are out there are doing innovative things and figuring out their new role in the environment.
Gary asks how we can get payers more engaged with the HIEs. Jocelyn thinks the people who have focused on use cases and real business problems are the ones who will be viewed as a trusted partner when situations like a hurricane or pandemic arises. Payers will be more likely to wire in with HIEs when they are solving real business problems.
Jocelyn hopes there are real, meaningful dollars put in place, so public health has an equal footing when it comes to implementation guides. Population health is complicated because there are so many endpoints. She hopes what we take out of this is that we need to seriously invest in our infrastructure for public health, then we all will win.
Ken adds that on some issues, states are going to do things their own way, but when it comes to a pandemic, we need a more national approach. We are on our third attempt at a nationwide exchange, which is still, realistically, several years away. There may be some successes with the current HIE structure, yet in some areas like public health, it has proven to be inadequate. ONC is starting to fund some of these areas.
Gary asks if there is any movement on a national patient identifier. Pooja mentions that ONC recently held listening sessions on universal patient identifier and a national patient identifier. She notes we are waiting to see if congress passes legislation to allow research on it. Pooja thinks we should look to other industries, outside of healthcare, who are doing this today, such as the financial industry. Other questions also arise concerning privacy and security. How do we share necessary information in a secure manner?
Gary asks Jocelyn what she heard at the conference about USCDI. Jocelyn says the team at ONC recognizes there needs to be more frequent updates and ways for the public to impact what’s in USCDI. There is a path forward to include ways for people to submit new ideas and to rely less on big annual/bi-annual updates. This becomes important as the expanse of people participating in the FHIR community gets larger and other stakeholders get engaged. The introduction of this new process to be able to expand and advance USCDI independent of the big turn of the wheel, is important for those who are implementing in the market.
Gary asks Ken what he heard about labs. Ken notes key challenges like terminology and distributing results. For example, physicians may be ordering what they think is a certain lab test when they are actually getting another because the names are so similar, a capitalized letter could mean the difference between two tests. Then, you also have the challenge of distributing results. Public health often does not get results for a week or more after the results are known. The test results pass through many different places, which can sometimes also result in lost information.
Pooja’s final remarks talk about players on the bench, those who are waiting to get into the game. This is everyone outside of the main groups, including long-term care facilities, pharmacies, specialty providers, labs, or social determinants of health. She says that if we don’t invest in these groups, we will not be able to accomplish what we are trying to achieve.
Jocelyn is starting to see the work from the past several years produce itself in meaningful ways. She appreciated hearing from those on the frontlines who are using the tools at hand. Our healthcare system has unique challenges due to both our economic and political landscape, but there are plenty of opportunities for us to continue to lead around things like APIs and FHIR.
