ONC's Rucker: 'There will be market transformation'

ORLANDO, Fla.—From banking to travel to taxi rides, mobile technology has transformed the world economy. It's healthcare's turn, according to National Coordinator for Health Information Technology Dr. Donald Rucker.

Ensuring that the smartphone and application programing interfaces—APIs—become ingrained in the industry was central to proposed regulations the CMS and ONC put out earlier this week, Rucker said during a closing keynote at HIMSS19.

Speaking with HIMSS President and CEO Hal Wolf, Rucker said the federal agencies had two straightforward goals: open up data to empower patients and other providers to explore new ways of delivering care; and put the "kibosh" on data-blocking.

"There will be market transformation," Rucker contended, pointing to Uber, Lyft and remote banking as examples of how APIs can reshape industries and the consumer experience.

But change won't happen overnight.

"It will take to time pull all of the data together, normalize it and make sure it makes sense" to patients and other providers, said Chuck Christian, vice president of technology and engagement at the Indiana Health Information Exchange. "Just because patients or doctors have the data, is it useful?"

CIOs are also leery of additional costs they may incur from the proposed rules, which would require hospitals to send immediate notifications when a patient is admitted, discharged or transferred. Insurers engaged in any federal activity, ranging from Medicare to insurance exchanges, would have to give patients immediate electronic access to claims data.

"There is a cost for doing all of the plumbing. And there is overhead to maintain it," said Michael Reagin, senior vice president and chief information and innovation officer at Norfolk, Va.-based Sentara Healthcare, adding that the overall intentions are good since they are intended to create a more informed and engaged patient.

Rucker said patients should be able to connect to a provider's system with the app of their choice and access their medical information at no cost. When it comes to provider-to-provider or vendor-to-provider interactions, the proposed rule allows for organizations to recoup "costs that would be reasonably incurred," Rucker added.

Casting the net wider, Rucker noted that the ONC and CMS are also engaged in an effort to reduce clinician burden when using information technology. This endeavor is technically separate from the rulemaking, but there are linkages.

In an initial report that came out last year, the ONC drilled down on a handful of areas that are ripe for improvement. Rucker specifically called out refining clinical documentation and standardizing prior authorization during his remarks.

"We have computers everywhere, but there are people sitting behind all of those computers," he said, suggesting that the push for better connectivity and the use of APIs can further drive automation.

The CMS, through an industry project called Da Vinci, is assessing ways to tap into technology standards to better automate the prior authorization process, said Melanie Combs-Dyer, a deputy director at the agency. For instance, if prior authorization is required, clinicians might be able to initiate that right from the electronic health record and get an answer back from the payer.

Dr. John Fleming, ONC's deputy assistant secretary for health technology reform, said the potential is even broader, including cost transparency. He said there is a complex series of actions and communication that need to take place between technology systems, but the goal should be for a patient to leave a care setting with approval for their next visit and an understanding of their out-of-pocket expenses.