Response to ONC RFI on advancing interoperability of EHRs and HIE

At last weekend's #healthfoo I proposed that one unconference session be devoted to preparing a comment letter responding to the ONC RFI on Advancing Interoperability and Health Information Exchange.

We discussed three possible sub-regulatory changes (which is what ONC asked for), and reiterated the value of a specific regulatory change that would not require a new rulemaking process, because it may be incorporated into the final rule on patient access to lab results (draft rule released in 2011, no final rule yet).

Specifically, we proposed:

• Leverage existing regulatory requirements by building meaningful use of EHRs and HIE into the lexicon of the health care facility surveyor; a Meaningful User should be cited with a deficiency specifically citing the EHR use or misuse or non-use if proper meaningful use would have eliminated the root cause of the deificency.
• Advance provider directories to support HIE by using the attestation process to link a provider's Direct address with other contact information in the National Plan and Provider Enumeration System (NPPES, NPI system).
• Increase patient access and use of EHR information by developing patient education programs as well as improving usability of the patient interface.
• Increase standards-based electronic exchange of lab results; see Keith Boone's reg change proposal and my reply to Farzad Mostashari's tweet ("Lawyers: Would this work?") about Keith's post.

Here is the Health Foo letter to ONC on its EHR interoperability RFI.

The discussion that yielded this comment letter followed hard on the heels of a discussion about Meaningful Use Stage 3 facilitated by Claudia Williams of ONC, so we certainly hope that ONC is listening.

(Click on the image above to see Regina Holliday's painting, Open Doors, painted over the course of the unconference.)

I was also involved in the preparation of the ONC comment letter filed by the Society for Participatory Medicine, which covers most of the same ground, and also promotes adoption of Blue Button Plus as a means to empower patients to a degree that current systems do not allow.

These letters are addressed both to ONC and to CMS, in response to their joint request for information. This collaboration within HHS is encouraging, and it may well point to greater interest in leveraging EHRs within CMS. 

David Harlow
The Harlow Group LLC
Health Care Law and Consulting