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D.C. Report: Mostashari says, 'Now is Not the Right Time' for NwHIN Governance

September 11, 2012
by Jeff Smith, Assistant Director of Advocacy at CHIME
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Jeff Smith, Assistant Director of Advocacy at CHIME

Health IT Policy Committee Gets MU Stage 2 Briefing, Learns of Decision to Pause Nationwide Exchange Governance Plans During the 40th meeting of the Health IT Policy Committee held in Washington this week, members were given an overview of Meaningful Use Stage 2 by officials from CMS and ONC.  And in the waning hours of the day-long meeting, Dr. Farzad Mostashari revealed that ONC has decided to put plans for further regulation of the Nationwide Health Information Exchange (NwHIN) on hold.  In opening remarks made Thursday, Dr. Mostashari called the MU Stage 2 regs, “predictable” and joked this made for bland news headlines.  He reiterated his commitment to seeing “actual exchange” and his agency’s belief that patient-dependent measures, like the 5 percent thresholds in measures related to patient portal use and secure messaging, was the right thing to do.  Committee members were then briefed on Stage 2 rules, followed by presentations on the National Strategy for Trusted Identities in Cyberspace (NSTIC) and its application to the healthcare world.

The real bombshell was delivered at the end of the day and was not included in presentation materials made available before the meeting.  Dr. Mostashari said ONC received over 140 responses to a Request for Information regarding a plan to implement a governance mechanism for NwHIN.  The main theme?  “Now is not the right time,” he said.  “There’s a lot already happening around health exchange. There are different governance models emerging,” he continued, citing recent announcements made by NHIN Exchange officials to spinoff governance duties to a non-profit HealtheWorks and other initiatives.  However, he also said that where the agency sees inaction and reluctance on behalf of the market to push exchange due to a lack of trust, there will be action.  "Just to be clear, trusted exchange as quickly as possible is the goal," he said.  Instead, the agency will now take a more backseat role in coaxing the policy goals sought through the RFI.  A slide presented during the meeting said ONC plans to “lead through guidance,” “engage, listen and learn” and “monitor” marketplace successes, gaps and failures.

For its part, CHIME commented on the NwHIN Governance RFI in June 2012.  In a letter submitted to ONC, CHIME worried that “rulemaking relating to NwHIN governance is being unduly rushed.”  Instead, we urged, “ONC to consult more thoroughly with the existing HIT Policy and Standards Committees regarding NwHIN governance and related matters,” as well as “consider other mechanisms for facilitating a dialogue regarding these matters, such as a ‘Town Hall’ meeting.”

“In the absence of more extensive consultation and dialogue, we believe it would be a serious mistake to issue a notice of proposed rulemaking regarding NwHIN governance in the near term,” CHIME comments said.

Lawmakers Turn Attention towards Health IT and ACA Implementation Following the hubbub of the Republican and Democratic National Conventions, lawmakers are turning their attention to the legislative agenda leading up to November 6.  While most casual observers might believe that nothing gets done between Labor Day and Election Day, health policy wonks know better.  Both the House and Senate committees are planning to focus on health care law when the return from their August recess next week.  On the House side, two Ways and Means Subcommittees will highlight implementation problems related to the ACA, ranging from health insurance exchanges to duties not yet addressed by the Internal Revenue Service.  “Given this massive undertaking, the hearing will allow the subcommittee to hear about the progress and the pitfalls associated with this unprecedented expansion of government into America’s health care system,” Ways and Means Health Subcommittee Chairman Wally Herger, R-Calif., said in a written statement.  In addition to the ACA-focused hearings, The House Committee on Science is considering whether to hold a hearing on Meaningful Use, following publication of Stage 2 final rules this week.  Rumors have it that the Committee was planning for a hearing September 13, though it now appears that the 13th is the date of a memorial service for the late astronaut Neil Armstrong, Congressional Quarterly reported

IOM: U.S. Healthcare System Squanders $750 Billion a Year; Science & Tech Key to Fixing Throughout the years, the Institute of Medicine has produced many studies that helped transform the healthcare system.  Over a decade ago, To Err is Human and Crossing the Quality Chasm drew attention to preventable harm and poor performance in healthcare.  Now, they are making headway into healthcare inefficiencies, ballooning costs due to the complexity of the system and poor quality of care with the report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.  Without action, the healthcare system will continue to fall short.