HIMSS: ONC's pathway, today and tomorrow

NEW ORLEANS—Being the national coordinator of health IT is “not like being the CIO of an enterprise,” said Farzad Mostashari, MD, ScM, during the March 4 Office of the National Coordinator for Health IT (ONC) Town Hall Meeting during the Health Information Management and Systems Society (HIMSS) annual convention.

“The ONC is more like a loose city planner that tries to think of common sense rules,” he said. “Our hope is to be as supportive as we can to the plurality of efforts out there. We won’t get everything right, but we will always try our best.”

The ONC’s greatest resource is its people, Mostashari said. Nine leaders in the various offices of ONC introduced themselves and described their roles in the effort to “make Meaningful Use as meaningful as it can be” and “moving interoperability and information exchange from committee to community.”

“Meaningful Use is not an endpoint,” said Jacob Reider, MD, ONC’s new chief medical officer. The new CMO office consists of five physicians and four nurses who will channel clinicians’ interests, needs and frustrations into the rest of the work done by the standards, policy, patient engagement and other teams, he explained.

Lygeia Ricciardi, director of the Office of Consumer eHealth, said her office has a “three A” strategy: access, action and attitude. “We want to give people access to their own information electronically. Action is about enabling the development of tools, growing ecosystems and resources that let people do something with their health information. Attitude is about encouraging people to feel much more comfortable in a partnership with their clinician.”

When asked about ONC’s ability to impact the broad range of clinical quality measures, Reider said, “We can only change what’s in scope for us.” While he doesn’t know when it will be completed, an effort is underway to align quality reporting programs. “We have started the work.” The Agency for Healthcare Research & Quality website, for example, offers a single source that lists all clinical quality measures for Meaningful Use Stages 1 and 2.

When asked about standards beyond Meaningful Use, Douglas Fridsma, MD, PhD, director of the Office of Standards and Interoperability and acting chief scientist, said, “ONC’s interest in establishing standards that will support interoperability exist now for Meaningful Use as well we beyond that.” The HITECH Act gave ONC the charge to establish implementation guidelines for health IT and that authority was not tied to incentive monies.

“A lot of what is in Meaningful Use should be foundational for other things coming down the pike, such as healthcare reform, Beacon communities and accountable care. All of those things are going to be important aspects of what we do. Our job at ONC doesn’t end when it comes to the Meaningful Use program and the end of the incentive funding.”

Fridsma also said ONC works with the innovation community to “take the path of least regret.”

When asked whether ONC will mandate encryption standards, Joy Pritts, chief privacy officer, said the agency has certainly encouraged encryption. “We have given people the tools, we have given people a get-out-of-jail-free card if they do encrypt. We recognize that patients sometimes just want their data and they have a right to get it.” If providers offer a warning to patients requesting access to their records in a certain format that is not secure, they have done their duty, she said.

Pritts also said ONC builds protection “into everything we do.” She noted that healthcare really needs to focus on cybersecurity and a lot more effort is coming.”

David Muntz, MBA, principal deputy health IT coordinator, said Meaningful Use is a gem that can be exported to other countries that have indicated interest. “Others can take what we’ve done focusing on quality driven around patient centeredness and we can provide direction.”

When asked how he envisions health IT and ONC is 2020, Mostashari said the longer term vision, beyond Meaningful Use is smart health. He said he envisions a future in which “every interaction benefits from all the world’s knowledge and every encounter generates knowledge that adds to the world of knowledge. I sure hope that every encounter will be conducted with the benefit of health IT.” If that is not the case, “we haven’t met the challenge of our time.”