ONC's Rucker Discusses Solutions to Healthcare's Technology Challenges

There are 3 components of the 21st Century Cures Act that will benefit accountable care organizations (ACOs) and improve their ability to communicate and share information, said Don Rucker, national coordinator of health information technology (IT) in HHS’ Office of the National Coordinator (ONC) for Health IT, at the spring 2018 conference of the National Association of ACOs.

Interoperability has been an ongoing issue in healthcare, and Congress sought to improve the ability to communicate in 2016 when it passed the 21st Century Cures Act, he said. The law was passed with overwhelming bipartisan approval and was signed into law by President Barack Obama just after the 2016 presidential election, and the current administration continues to stand by it.

“I can assure you that the Trump administration, [HHS] Secretary [Alex] Azar, [CMS Administrator] Seema Verma, [and] ONC, we’re very much all about getting that shared vision of modern computing to all of you and to the country at large,” Rucker said.

It has become apparent that, while electronic medical records held promise for automation, they have become a burden, with clinicians spending hours each day in front of the computer, a lack of raw usability, and challenges connecting.

There are 3 major components in the 21st Century Cures Act that will fix the technology challenges facing healthcare, Rucker said.

The first component is a prohibition against information blocking. There is a narrative, Rucker explained, of providers and vendors not sharing information and making it difficult for people to get access. ONC hears complaints from payers and entrepreneurs who can’t get access to the information, but also from providers who have trouble getting their own data.

The second component is the Trusted Exchange Framework Common Agreement, which is a way for all the various networks to talk to one another.

The third component is an open API, or application programming interface, without special effort, which refers to how 2 pieces of programming talk to one another. The idea is to get the modern app economy into healthcare, Rucker explained.

“That is going to be very profound in healthcare,” he said. “That is going to allow new business models and disruption in big ways.”

The classic idea of interoperability is for a doctor at one organization caring for a patient to see the records another doctor has who cared for that same patient. But for consumers, that’s not a very empowering definition of interoperability, Rucker said. Congress wanted interoperability to benefit patients more directly, he added, and the idea is for patients to have access to their medical data on their smartphones.

“[The smartphone] is the tool in our modern era to get patient engagement,” he stated. “We’ve been talking about patient engagement forever—my entire career. How do we motivate people? Well, if they’re sitting on their smartphone, that seems like a pretty good place.”

The open API without special effort, will also help with population-level data. ONC is currently working with people in the industry to build tools that will allow for data standards to look at population data. Such a tool will also allow payers to decide what they’re purchasing and allow ACOs to figure out who to contract with.

“That tool will, I believe, supercharge what ACOs can do,” Rucker said.