Donald Rucker, M.D., who was named National Coordinator for Health IT in the spring of 2017, has been focusing his tenure as National Coordinator on a handful of top policy priorities for the Trump administration, among them, interoperability across the U.S. healthcare system, via, among other elements, the Trusted Exchange Framework and Common Agreement (TEFCA), and the overall 21st Century Cures Act of 2016, out of which TEFCA emerged; and reducing the administrative burden on physicians and other providers, as articulated in recent speeches at major healthcare conferences by Alex Azar, Secretary of Health and Human Services, and Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS).
Dr. Rucker continues to speak at all the major industry conferences at which national health IT leaders gather, including at the annual HIMSS Conference. And he recently spoke with Healthcare Informatics Editor-in-Chief Mark Hagland to talk about his current efforts, and how he sees industry evolution towards greater interoperability and healthcare system transformation. Below are excerpts from that interview.
What are the main areas you’ve been working on recently, Dr. Rucker?
We’re still working on the things that I’ve talked about publicly—the rulemaking in process on open APIs, information-blocking, TEFCA; and we’re sorting out what we can do on burden reduction. We’re still pretty much working on the exact same things that we had been working on before.
Donald Rucker, M.D.
What are you putting the most energy into right now?
Obviously, an aggregate 21st-Century Cures has a number of specific provisions. By law, we have to work on all of them, and by law and federal rulemaking processes, they’re sort of going to come out together. That’s in the list of upcoming rules. So they sort of come out as a pack; and they all feed off each other on some level; some feed off each other directly. The focus on open APIs, and preventing information-blocking, sort of mutually reinforce each other. And clearly, that was the explicit intent of Congress. The broader intent, probably of the prior administration and certainly of this administration, is for us to get more for what we pay for in healthcare. It’s no secret that we’re not getting a good deal in American healthcare. And certainly, that idea picked up a lot of steam with Don Berwick and the IHI [Donald M. Berwick, M.D., the former CMS Administrator and the president emeritus of and a senior fellow at, the Cambridge, Mass.-based Institute for Healthcare Improvement], and similar efforts. And, I’m not a pollster, but I’m told that’s a major issue in voters’ minds. All of us are seeing our prices rising, as consumers.
And with all of that going on, one of the big opportunities, I think, and the White House thinks—Jared Kushner in the Office of American Innovation, and Secretary Azar and Administrator Verma, all think, and certainly I do as an IT person—everybody sees that IT is one of the potential keys to the kingdom, in terms of rethinking business models, and achieving accountability. Right now, as a provider, there is no broad-based, computational capability around what you do. You may have to provide a narrowly scoped set of quality measures; and private payers may ask for some specific data downloads; but there’s no clear interoperability standard to look at the overall performance of providers, with any of the modern computer science tools we hear about—AI, machine learning, big data. You can talk about big data all you want, but if there’s no computational interface, it remains limited, often right now to individual providers. Ultimately, we’ll need to get data out from all providers simultaneously, to be able to shop intelligently for care, identify disease outbreak threat vectors, etc. So those are some of the things the senior federal healthcare officials are thinking about.
Secretary Azar spoke about hospital pricing transparency, and the potential for direct physician contracting, in his keynote address at the World Health Care Congress at the beginning of this month. And he and Administrator Verma both spoke of the freeing of data to support the new healthcare, particularly to support healthcare consumers.