ONC Annual Meeting: Town Hall covers mandates, alignment, future

A lengthy roster of Office of the National Coordinator for Health IT (ONC)'s leadership participated in a Town Hall session during the office’s Jan. 23 annual meeting, touching on a wide range of topics.

The panel was asked what is being done to help pharmacists and other providers who are not eligible for the Meaningful Use program. “We are looking at how we can leverage the certification program to be broader than just for those participating in Meaningful Use,” said Jodi Daniel, JD, MPH, director of ONC's Office of Policy and Planning. Behavioral health and long-term care providers are high priorities, she added. A team is working on ways to best include more providers.

“We’re not just about Meaningful Use,” said Judy Murphy, RN, deputy national coordinator for programs and policy. The move from implementing EHRs to optimizing their use requires ONC to “not just address other venues of care but make sure we’re addressing the patient-centered record and make sure that everywhere the patient goes the record follows and the important information is known.”

Kelly Cronin, health reform coordinator, said ONC is figuring out how to accelerate interoperability and support adoption of health IT by long-term care and behavioral health providers. Also, “we want to make sure that, as accountable care organizations mature, we’re thinking critically about how we weave health IT into that. How do we advance exchange as a series of applications including those that reach patients and make sure this all fits together.”

ONC has been focused on EHR adoption for the past several years with “important investments in standards and interoperability and network services,” Cronin said. Now, the office is working on bringing the ecosystem together.

“Our business model for healthcare drives, in some cases, overutilization, said Karen DeSalvo, MD, MPH, MSc, national coordinator. “It is imperative that we figure out how to stop that from happening.”

An audience member asked the panel if there are efforts to make the Meaningful Use requirements more flexible for those providers who don’t have a lot of direct patient contact.

“As much as we understand the predicament, the law and the regulations are what they are,” said Jacob Reider, MD, ONC’s chief medical officer. “A lot of our work has focused on how the folks that typically are not eligible [for Meaningful Use] may actually be participating in the care delivery system. Our scope is broader than Medicare beneficiaries so we try to focus on what health IT can do to empower the providers.”

When asked about the future of regional networks that have sprung up, DeSalvo responded. “I understand how it feels to be part of one of these networks and how powerful that can be for diffusion of care. You are valued. Change will happen at the practice level.”

A stable budget allows innovation, she added, because so many in healthcare often are working in the margin. DeSalvo cited the effort to use waivers in stages in Oregon “where they thought about stabilizing budgets going forward and allowing innovation to happen on the ground.” That includes redesigning workflows and retraining the workforce. If the state’s efforts work, ONC will consider how to scale it nationally, she said.

A representative of the Kentucky regional extension center said there is a lot of demand for the organization’s services beyond Meaningful Use, especially the federal mandates facing providers. “I’ve seen the pain,” DeSalvo said. "The complexity is there. We want to make sure we do not make it so complex that it interferes with patient safety or care or the joy of practicing medicine. The laws and rules and regulations are a necessity but we want to make sure we make this convenient and realistic for everybody.”

Cronin told the audience it is time to get engaged at the community level. Murphy acknowledged that getting an EHR implemented is the easy part. Now, the industry needs to leverage the systems to “actually change the way we deliver care and deliver on the promise we all believe in.”