The much-anticipated release of the Office of the National Coordinator for Health Information Technology's (ONC) final rule is a seminal moment, ushering in the next phase of health IT reform.
Over the last decade, the U.S. government has spent billions of dollars incentivizing the adoption of electronic health records (EHRs) to enable higher-quality, more affordable and more efficient care. This has led to the widespread adoption of EHRs, with 87 percent of physicians and 94 percent of hospitals now using them regularly to help take care of patients (source). Unfortunately, this proliferation of EHR adoption in a short period of time has resulted in a patchwork of different systems exchanging disparate types of data in various ways. This has resulted in systems that can't talk to one another and limited access to important health information. This problem is acutely felt by healthcare workers who print, send and receive faxes every day to exchange even basic information.
For many years, EHRs have been the main system for capturing clinical data, but important health information is now also increasingly being captured via other technologies such as medical devices (vitals), diagnostic tests (genomics data) and consumer applications (patient-reported outcomes).
Faced with both the widespread adoption of EHRs and the rapid uptake of these other technologies, the government's attention is now shifting towards how to make these systems talk to each other and get patients all the information they need to manage their health.
The next phase of health IT
ONC's new regulations are focused on improving the interoperability of health information, enabling more health IT innovation, helping providers improve care delivery, and ensuring patients have access to their data. Through these new standards, ONC requires health IT systems to interact seamlessly with third-party applications and encourages the flow of information between health systems and patients.
The consistent adoption and use of data standards for health data capture and exchange is critical to widespread interoperability and system reform. This is why ONC defines not only how data should move (through FHIR-based APIs), but what data should move, via a new standard data set called the U.S. Core Data for Interoperability (USCDI) that will evolve over time.
The new standards will result in healthcare information that can more easily be shared between healthcare providers, researchers, systems and patients.
Why this matters
Patients with complicated diseases often see a variety of clinicians. For cancer patients this can include their primary care doctor, medical oncologist, radiation oncologist, surgeon, physical therapist, psychologist, social worker — the list goes on. Too often each of these providers lack patients' important — or sometimes any — medical history, as well as information from previous doctors they've seen. As therapies become more effective and patients live longer, data "portability" will only become more important to ensuring future physicians and caregivers have all the information they need to take care of their patients and loved ones. This comprehensive health information is particularly powerful for people with a history of cancer ("survivors"), enabling them to more easily transition to life after cancer.
These new standards will enable better health record portability regardless of where a patient's been or who they saw, ultimately allowing providers to make decisions based on the entirety of a patient's healthcare history.
What's next
Cloud-based technologies and new products built with an "interoperability first" approach will be well positioned to take advantage of and innovate upon the ecosystem that will unfold over the next few years.
The government has already laid out the vision for the next phase of this evolution specifically focused on research opportunities and building on today's new rule. In January, ONC published the National Health IT Priorities for Research , which addresses how we can begin to use our national system of EHRs and interoperability standards to advance care and improve patient outcomes faster.
With increased interoperability comes the ability to share that information with those who need it most: patients and those taking care of them. This concerted effort should finally allow us to realize the original promise of health IT, and perhaps this is even the beginning of the end of the fax machine.
