On Monday morning, Donald Rucker, M.D., the National Coordinator for Health IT, spoke broadly on issues around the interoperability and usability of data, access to data on the part of consumers and payers, and the intersection of health information exchange (HIE) with those issues, in the opening keynote address at the SHIEC Annual Conference, being held at the Crowne Plaza Indianapolis Downtown Union Station in downtown Indianapolis, and sponsored by SHIEC, the Strategic Health Information Exchange Collaborative.
Dr. Rucker, who became National Coordinator in early spring of this year, has spoken frequently about the challenges and opportunities around interoperability, since joining the Office of the National Coordinator (ONC), a division of the Department of Health and Human Services (HHS), at the end of March.
To some extent, Dr. Rucker on Monday reiterated some of the points he had made on July 24, when he appeared at the ONC’s first sponsored meeting around the development of a trusted framework for data exchange. As Healthcare Informatics Managing Editor Rajiv Leventhal noted in a report on the July 24 meeting, “During the session, Rucker outlined three important outcomes for a trusted exchange framework... First, patients can access their health information electronically without any special effort. Second, providers and organizations accountable for managing the health of populations can receive necessary and appropriate information on a group of individuals without having to access one record at a time, which would allow them to analyze population health trends, outcomes, and costs; identify at-risk populations; and track progress on quality improvement initiatives. Third, the health IT community should have open and accessible application programming interfaces [APIs] to encourage entrepreneurial, user-focused innovation to make health information more accessible and to improve electronic health record (EHR) usability.”
At the SHIEC Conference this morning, Rucker reiterated some of the main points he had made last month. And he asked the question, “How do we get our hands around the challenges of interoperability? It’s the exact same challenges you face every day,” he said. “Messaging, patient-centered medical homes, are all wonderful things. As ONC looks at use cases on interoperability,” he said, we’ve sort of come down to three use cases. A core foundation for these three use cases is smooth provider-to-provider interactions. Meanwhile, the first use case is electronic access to patients’ records by patients. What Congress had in mind is, you can point an app at a provider, and get the data. You already have the legal right to get your records in 30 days, under HIPAA [the Health Insurance Portability and Accountability Act of 1996]. So let’s harness those powerful computers to collect our medical data. That allows us to shop for care and better understand the care we’re getting. That’s direct access.”
Donald Rucker, M.D.
Rucker went on to say that “The second use case is really about sort of the broader interoperability en masse. It’s sort of getting the bulk of data” to be available to all appropriate owners and users of that data. “First and foremost, on a practical level, are the payers” of healthcare—the federal government and state governments and health insurers and employers, he said. Appropriately making data available supports the development of the concept of the learning healthcare system, supports research, and supports clinical registries, Rucker said, with that last element mandated under the 21st Century CURES Act, passed by Congress and signed into law by President Barack Obama on Dec. 13, 2016. Among the diverse provisions of the law are ones that encourage the interoperability of electronic health records (EHRs) and patient access to health data, and discourage information-blocking. Healthcare IT leaders have largely been very supportive of that law.
Encouragement for Open APIs
One element in all of this that Dr. Rucker strongly encouraged was the development of open application programming interfaces, or APIs. “The third use case,” he said Monday morning, “is around how we define an open API.” He referenced an app on his smartphone that had helped him locate the entrance to the conference center at the Crowne Plaza, which is somewhat in terms of the view of it from the street. “All I had to do was to look at my map on my smartphone,” he said of the experience. “That’s a wonderful example of an open API. You can go to Google Maps and it will feed you back a map. Those types of things. And it’s that kind of thing that Congress was thinking about” when both houses of Congress passed the 21st Century Cures Act last year, he emphasized. “So,” he said, “we have to think about open APIs in two very specific ways. One, what does that open API look like at the vendor level? And then, what does it look like at the provider level?” Data and IT security will be very important in protecting protected health information (PHI) going forward, he noted, but he said that that was something that could be accomplished.