The Department of Health and Human Services has released for public comment its draft of the 2020-2025 Federal Health IT Strategic Plan — which largely highlights the importance of empowering end users, leveraging data resources, increasing transparency and cybersecurity, as well as driving cost-spending efficiency.
The plan — which the Office of National Coordinator for Health Information Technology developed in coordination with 25 other federal organizations — has four overarching goals:
- Promote health and wellness — particularly by improving patient access to health information
- Enhance the delivery and service of care — especially in transparency and affordability — with health IT
- Build a secure, data-driven ecosystem to accelerate research and innovation that will help tackle health issues across the country
- Connect health care and health data through an interoperable health IT infrastructure — one that establishes transparent data-sharing expectations, enhances communication capabilities and secures health information.
Despite progress health care-driven agencies have made in developing electronic health records, one of the most pressing area for the federal health community to work on is ensuring patients, providers and other end users can take advantage of those records to improve care, said National Coordinator for Health IT Donald Rucker.
“Most health care providers and health systems now use electronic health records, but information captured in these systems often remains inaccessible to patients, caregivers and health care providers across different settings,” Rucker said. “All stakeholders in the health care sector will benefit from a fully connected health system.”
Even though the strategic plan has four goals, they meet at the nexus of empowering stakeholders throughout the health care sector. In meeting those four targets and to increase end-user empowerment as health IT develops, the strategic plan highlights several IT areas that agencies will improve upon over the next five years.
To empower patients under the plan, agencies will commit to pushing the development and use of application programming interfaces (APIs), especially with the Fast Healthcare Interoperability Resources standard, or FHIR.
APIs, the plan argues, will increase interoperability. ONC highlighted preexisting API initiatives at the Centers for Medicare and Medicaid Services, such as Medicare’s Promoting Interoperability and the Merit-Based Incentive Payment System, which have reinforced interoperability. Supporting initiatives like this will continue under the guidance of the strategic plan.
“Spurred by regulatory actions from ONC and CMS, it is increasingly using APIs to develop tools that provide patients and caregivers with their data and promote information sharing,” the plan states.
As agencies build out EHRs and other health IT solutions, the strategy acknowledges that ensuring Americans have access to technologies that can connect to those solutions is another area to build upon in the coming years. Building out digital services will be critical in this effort.
For instance, the plan wants to expand health mobile apps to make on-the-go access to care important, and it also emphasizes that agencies need to address disparities in access to technologies so that Americans have equal access to care and health data. This requires efforts such as expanding broadband access and infrastructure, deploying cloud-based services to make data more readily exchangeable and improving telehealth care.
“Minority, low-income, tribal and rural populations are less likely to have broadband internet service at home than others,” the plan says. “Lack of access to broadband-dependent technology and health information made available through technology can further exacerbate existing health disparities by creating a barrier to the range of technologies that support cost-effective and high-quality care.”
The plan also mentions throughout that improving EHRs to reduce administrative and provider burden is critical. EHRs have thus far succeeded in supporting reimbursement and financial processes, but the plan intends to leverage EHRs to expedite clinical documentation and authorization steps as well over the next five years.
To further improve care and help providers in clinical decision-making, the plan emphasizes collecting, organizing, analyzing, interpreting, and applying big data. As EHRs and other new technologies make capturing health data easier, leveraging data and applying it to machine learning, automated solutions, and other emerging technologies, HHS and ONC recognize that optimizing data usage is a critical area for agencies to hammer down.
Sharpening data collection and analysis, as well as data-driven applications, will also help researchers and public health workers — part of the third pillar of the four overarching goals. Supporting these efforts can provide better insight to improve both health care delivery, as making significant discoveries in medicine often requires access to and analysis of mass amounts of data.
“Public health workers, researchers and community-based organizations increasingly use health IT outside of the care setting to assess health and health care quality across different individuals and populations so they can address health and related social disparities, lower costs and improve outcomes,” the plan says. “This often entails using health IT to exchange health information for population health activities and to collect data on reportable conditions to prevent and stop disease outbreaks.
Data-driven initiatives to make significant leaps in medical discovery already exist across agencies. The All of Us initiative at the National Institutes of Health, for instance, is a precision medicine research program that gathers individuals’ volunteered health data to build a diverse database that will inform future studies on various health conditions.
As EHRs — which often store data in a centralized cloud environment — increase data collection capabilities, the plan also recognizes that securing individuals’ health data is critical. Although the plan calls upon agencies to prioritize cybersecurity, it underscores that the effort will overall require collaboration with health care providers, health IT developers, researchers and other stakeholders to maximize security.
Returning to patient empowerment, the strategy not only demands data security but transparency as well. Patients, moving forward under this plan, will not only have access to their health information but know how the government and its partners are using their data and have a choice in how their data is used.
As agencies tackle this web of goals over the next five years, controlling the growing cost of care looms over all areas of work. National health spending was at $3.5 trillion in 2017 and is expected to reach more than $5.3 trillion by 2025 — a growth rate of about 5.4% in spend per year, largely caused by a growing and aging population.
To reduce spend, the plan intends to use federal resources judiciously by relying on private-sector partners as much as possible— a process that will foster competition throughout industry developers to create the most efficient solutions to drive the goals of the strategic plan.
Since the execution of the strategic plan will require heavy cooperation with industry and other non-government partners, the draft release of the plan includes a period of public comment through March 18.