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ONC's federal health IT strategic plan shows growth -- to a degree

ONC's five-year strategic health IT draft plan lays out comprehensive goals, but, in some instances, how to achieve those goals is still murky.

A draft of a five-year federal health IT strategic plan was applauded by stakeholders for its comprehensive goals, but one expert pointed out its lack of directives on becoming interoperable with systems outside of healthcare as well as workforce development.

The Office of the National Coordinator for Health IT's strategic plan will serve as a "roadmap for federal agencies" to prioritize resources and coordinate health IT efforts once it's finalized, according to ONC. It includes goals to improve patient access to data and foster greater transparency in healthcare. The plan was developed in coordination with more than 25 federal organizations, according to ONC.

Jeffery Smith, vice president of public policy for the American Medical Informatics Association, said the draft does a good job of moving away from the more EHR-centric federal health IT strategic plans of the past and sets a good framework for what ONC wants to accomplish.

Jeffery SmithJeffery Smith

But Smith said how ONC plans to achieve the goals it outlined is murky in some areas. It lacks details around, for example, what clinical measurements ONC will use to determine the quality of patient care being delivered, as well as how ONC plans to train employees to accomplish these goals.

"The plan is surprisingly light on workforce development, and I think that's to the detriment of the plan," Smith said. "There's really very little conversation here on the human component to how this whole plan is meant to come to fruition."

Lack of workforce development, quality measures

The four main goals listed in the federal health IT strategic plan are: promoting health and wellness; enhancing the delivery and experience of care; building a secure, data-driven ecosystem to accelerate research and innovation; and connecting healthcare and health data through an interoperable health IT infrastructure. Yet the document does not lay out a plan on how to train a workforce that can make these goals happen, Smith said.

To accomplish the ONC goals, a healthcare workforce would have know how to facilitate greater data sharing between hospitals as well as how to provide patients with better data access, something that has been a challenge for healthcare.

On top of that, sharing data with systems outside of the hospital is an even greater challenge, and something ONC is pushing for in its federal health IT strategic plan. But clinical information systems outside of EHRs often do not use the same data standards, according to Smith.

"One of the big things the government ought to be looking at is how to incentivize what has happened in the clinical data space for EHRs, which is a gradual and somewhat painful march toward better standardization, and how do we think about doing that outside of the EHR context," Smith said.

He also noticed clinical quality measurements were lacking in the draft plan. Their absence stood out to him because the idea of value-based care, a model that rewards payment based on quality rather than quantity of care, is featured prominently within the federal health IT strategic plan.

Clinical quality measurements have historically been part of the value-based care conversation, but they have also been a source of frustration in the healthcare industry, according to Smith. He said it will be difficult to move the needle toward value-based care without guidance on how to measure for quality, something he would like to see more about in the plan.

Plan offers comprehensive goals for health IT

While some areas need fine-tuning, Smith described the plan as a step in the right direction overall.

He believes the draft plan sets the stage for more mature health IT conversations in the next five years, pushing beyond an EHR-centric focus. For example, ONC is trying to advance clinical research and apply those findings back to patient care more quickly.

"We've always kind of looked at the promise of health IT as being this very grand vision of every patient encounter building toward a bigger body of knowledge and applying this bigger body of knowledge back to the individual encounter," Smith said. "This plan does a pretty good job of getting us closer to that grand vision."

Matthew MichelaMatthew Michela

Matthew Michela, president and CEO of Life Image and a member of The Sequoia Project, a nonprofit tapped by ONC last year to help lead the agency's interoperability initiatives, praised the plan.

Michela said he strongly supports ONC's push for greater patient access to data and believes the federal agency needs to take an even stronger stance on consequences healthcare organizations should face for withholding patient data.

"I'm really thrilled with the plan, it's incredibly comprehensive, well-organized and thought through," Michela said. "But my observation would be that it might not be strong enough." The public comment period on the federal health IT strategic plan draft will end March 18.

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