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ONC Promotes Market-Driven Solutions to Health IT Woes


At HIMSS18, less regulation and more market-driven innovation was the name of the game for the ONC's top officials.

Leaders from the Office of the National Coordinator for Health Information Technology (ONC) are all in on enabling a market-driven health ecosystem.

Speaking at the annual Healthcare Information and Management Systems Society (HIMSS) conference, held this year in Las Vegas, National Coordinator for Health IT Donald Rucker, MD, said the vision of the ONC is to "empower patients in a market economy to shop for care and to have competition so services make economic sense." To exemplify why he advocates for this vision, he talked about the correlation of rising health care costs and the creation of Medicare. He said studies in the New England Journal of Medicine show that the cost began to rise upward when Medicare passed in 1965.

"You always see these curves [on health care costs] and see the [upward] slope and it looks constant. Ask yourself, 'When did that slope start? When did the first derivative change?' That was in 1965 [when Medicare was passed]. Before that, patients shopped for their care."

John Fleming, MD, deputy assistant secretary for health technology reform at ONC, said one of the reasons government involvement in health care has yet to control costs is a lack of pricing transparency. There is no correlation between the bill patients get from a provider and the care that was actually given to them. Fleming said it's not the provider's fault, but the system which has heaped layer and layers of regulations. He said there needs to be better pricing transparency for the patient.

In this sense, ONC is providing support for CMS' relaunch of Blue Button. Blue Button 2.0, which was announced earlier at HIMSS , will incentivize health IT vendors to create tools that will allow patients to easily disseminate their health data, including claims data from CMS and other major payers.

Another lever ONC wishes to use to create better pricing transparency is open application programming interfaces (APIs). Rucker said this technology provides a "doorway to data," which allows different app developers to create products for consumers. "Those APIs are something every [developer and vendor] can write code against and that's what's been missing. It's not proprietary data," he said.

Rucker laid out how he sees the ONC's role in creating a patient-friendly apps and tools. "We want the software tools to be empowered and let the private sector figure out the best way to do the [patient outreach]. Do you think ONC is better at getting patients to access their data or Apple or Google or any new startup? I think the answer is pretty clear."

In regards to the lack of interoperability in health care, Fleming noted that one of the downsides to a highly regulated system is that it stifles innovation. He says if it weren't for a highly regulated environment, "we might have [had] interoperability 10 years ago."

Usability of EHRs

Later in the session, ONC tackled the idea of better usability of EHR systems. Rucker said there are a lot of different factors - some of it's based on technology, some comes down to  doctors themselves.

"Docs are pretty bad at giving programmers advice in how to build things. The docs think they're logic machines, they just assume that. The human brain, we're pattern recognizers… You'd design a different system...less pulldown menus and widgets…if you realized we're pattern recognizers, but I think the private sector is going to sort that out. A lot of the vendors are trying things."

The ONC, Fleming said, isn't taking a complete hands-off approach. It created four workgroups tackling the different aspects of this problem: quality measurement/reporting, documentation guidelines, preapprovals and certifications, and connecting EHRs to databases for better monitoring of controlled substances. These problems are low-hanging fruit, he said.

"It's going to get worse before it gets better if we don't get very serious about tackling the problems," Fleming said.

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