Dr Don Rucker, former National Coordinator for Health IT from 2017-2021, said he considers the current proposed structure of the Trusted Exchange Framework and the General Agreement and its dependencies. Getting into brokered protocols and 1990s style page view document architectures is an expensive one. obstacle to modern healthcare computing.
Under the proposed interoperability rule that requires providers of electronic health records and others to provide healthcare IT, resources with rapid healthcare interoperability are being developed. deployed.
“If we want to do business in the country to get value in health care, we have to somehow match the nature of the care with the amount we pay for that care, ” Rucker spoke during the HIMSS23 session about the series FHIR he co-presented.
“And before the FHIR, that was not possible.”
Rucker sat down with Healthcare IT News to discuss what needs to happen in a national healthcare interaction strategy. Read part one of the interview below and look for part two tomorrow.
Q. What have you been doing in the two years since you left the Office of the National Coordinator for Health IT? Talk a little bit about your role at 1upHealth and the work the company is doing to improve interoperability.
ONE. That is truly the modern vision of computing.
And when you think about healthcare computing, we now have a great combination when I actually think of three things.
So first, through a lot of work, we have a lot of electronic healthcare data. Quite a few people with electronic medical records like to think that ONC and my predecessors had a role in it.
And the ONC team, we really have a subtle underlying network approach to thinking about data in the cloud.
And finally, we have something that might be a little more subtle, but you know, when it’s missing, you definitely notice it’s missing. We have an elegant data representation standard in FHIR, which has taken the industry 40 years to achieve.
I think the combination of a lot of data, highly networked platforms that not only share data, but also allow you to compute – hence the cloud – and then have a data standard that you can be calculated by that is the driving force.
And at 1UpHealth, that’s what we do to help payers, who are under all sorts of pressure, combine clinical data and claims, and provide a platform for startups. digital health industry.
Ask. During your tenure at ONC, you covered the challenge of policymakers addressing multiple interoperability challenges at once – technology stacks, data exchange standards, interoperability consensus on semantics and meanings as well as business case, all with built-in privacy and security. How do you think we’ve tackled these complex and overlapping challenges in the 5 years since you said that?
ONE. I think the Cures Act, the original Cures Act API concept with no special effort – modern standards-based, not vendor-based APIs – I think is appropriate.
As a country, we are extremely fortunate because this is not something we have to invent.
It sits there between Restful APIs and OAuth2 for security and FHIR. It was there to take.
So the combination of a law with a technical solution is exactly what is needed, that’s pretty rare, isn’t it? To me, that’s a bit like eclipse.
That doesn’t happen often, and it’s 100% bipartisan.
Q. What needs to happen in terms of national strategy from now on? Want to see some policies that might not apply – and perhaps vice versa?
ONE. Well, I think it’s very difficult for the government to be able to let things go instead of offering more fixes. Patience and government – they don’t always go together.
I think with what we have with FHIR, OAuth and Restful [APIs]we actually have the technology stack we need.
So what would be useful? I think there are two kinds of things. First, what additional technical things would be helpful? And then, what additional policy things – which in healthcare are largely billing – would be helpful?
On the technical side, I think the one thing also in the Cure Act, which I guess CMS is working on, is the national supplier directory. We need discoverable endpoints for everyone who is monetizing CMS. They owe water; We owe it to ourselves.
That should not be done through brokers – [Qualified Health Information Networks] – that should be easily discoverable.
That’s probably the biggest technical thing that ONC has done some good work on – the endpoint directory in the certification program.
From a short-term policy standpoint, it’s clear that we have the Cure Act provision for APIs.
That is very powerful. That’s on the spot.
CMS extended it to the payment provider APIs and recommended interoperability role they commented on a few months ago. That I think will be the basis for discussions between payers and suppliers about things like quality measurement, pre-authorization, and network design.
In the beginning, this is possibly the most used part of the CMS API line.
We have to think about prevention. We must offer incentives and long-term health care for years if not decades. And we need to really find out, as a country, how do we really hedge the game?
Q. What do you think about TEFCA and where does it go? What benefits can it bring to interoperability – and what are some of its limitations, in your opinion? Is it an active network? Or could it really hinder broader data exchange?
ONE. We need a lot of computers. Finding the right care and pre-authentication is full of computer problems. So you want the platforms to have to do that. You need to calculate the individual data fields.
That’s the evolution of the Internet over the past 20 years. I think the concern with TEFCA is that it can focus on the classic interoperability case, that is, the former:
“I can’t get my paper chart.”
Of course now we solve that problem with a fax. So TEFCA is kind of an update to faxes when you get right into it. But it’s a kind of document-centric approach.
That’s a real use case without a doubt about TEFCA addressing. It’s narrowly focused when you compare what we can do today with what we could do 20-25 years ago and I think we need to think more broadly.
Not only do we need to get a record that you’ve had certain heart procedures, but we also need to be able to monitor your blood pressure, blood sugar, cholesterol, lipids, and micro-adjusts on real-time basis.
That’s what we need. Not that there was a document created three years ago about the last heroic treatment for your heart condition.
We need computers to prevent the next heart attack, and frankly, the next costly procedure.
So how do we get that computer into healthcare – that’s not going to happen with documents.
READ PART Two of THIS INTERVIEW TODAY
Andrea Fox is the senior editor of Healthcare IT News.
Email: [email protected]
Healthcare IT News is a publication of HIMSS Media.
