When asked if the agency will have sufficient budget and resources to carry out these responsibilities, Rucker said, “We think we do have the resources and time to do these tasks. Some of these things we are not legally able to work on until Congress handles certain aspects of the budget, and some of it is [the work of] other agencies like the GAO [Government Accountability Office].” But he did add that ONC will begin hosting a series of meetings later this month with the aim to establish a trusted framework and common agreement for health data exchange, as outlined in Cures. Morris added that the common agreement should be out for the public later this year or early in 2018.
Regarding interoperability, Rucker noted that it happens in pockets of the country today, and the sharing of lab results and images works well for the most part, but he pondered if the business model as it is today could extend beyond these few areas, and if there is enough of a business incentive for a patient’s problems list to be up-to-date and meaningful for all doctors to see, for example. “On the enterprise side with hundreds of providers, these problem lists are all over the place, and they go from screen to screen to screen. There is no business model to clean that up,” Rucker said. He added that ONC’s Interoperability Roadmap is a “solid path” but said there is no ETA for when some of those data sharing challenges will indeed be solved. “A lot of this is about more than just standards; it’s about business relationships,” he said.
Overall, when asked about the future vision of ONC and its role in the industry, Rucker said that philosophically speaking, ideally all of these regulations wouldn’t be needed, since that would mean many of the problems that exist today would be solved. To this point, he was asked when the meaningful use program will wind down, to which he responded that there is no date and that much of what’s to be decided is in conjunction with CMS. He did say that the focus is “not on finding more things to apply the meaningful use methodology to.” But for now, he said, for the next few years, it will be about making sure that EHRs are working so that physicians are not data clerks, but rather they can get value from the data that’s in the systems.
Fleming added that the changing reimbursement system is also a driver for much of this change. “Rather than pay for service, we need to pay for quality and outcomes. This is where CMS is putting effort and resources into, and this goes back to last administration—to their credit—in evaluating these [payment] models so people have the same incentives.” He noted, “The hope is that as we advance into better reimbursement and care models, some of these fee-for-service issues, documentation issues and usability issues begin to resolve themselves.”
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