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Can the ONC balance market freedom and regulatory action in the quest for interoperability?

The ONC wants “just enough” regulation to keep the market moving toward interoperability but healthcare stakeholders have a part to play too.
By admin
Mar 30, 2022, 7:00 AM

The road to interoperability has always been bumpy, with stakeholders pushed and pulled along by a combination of business incentives, consumer pressures, and federal regulations.

The Office of the National Coordinator (ONC) plays a significant role in guiding this march to appropriate access to timely, accurate, and comprehensive health data. By creating regulatory guardrails for the industry, convening stakeholders in conversation, and sharing technical knowledge, the ONC has helped the industry make meaningful progress toward its ultimate goals.

But the process isn’t an easy one, said National Coordinator Micky Tripathi, MD. The ONC constantly butts up against competing incentives, infrastructure challenges, and clashing ideas about how to best proceed.

Regulatory action can often settle these issues, but too many rules can bring unwelcome risks, Tripathi told attendees of ViVE 2022 in Miami Beach.

“Fragmentation makes it hard for the market to coordinate itself,” he said. “Federal regulation can play a role in helping people move in the same direction at the same time, and bring greater opportunities to create a meaningful ecosystem.”

“However, we want to make sure we have just enough regulation. But my definition of ‘enough’ isn’t going to be the same as yours. There’s a fine line between creating useful guardrails and being too heavy-handed for people to operate the way they need to.”

The 21st Century Cures Act provides many examples of the difficulty in achieving balance, particularly in the nebulously defined area of information blocking.  

“I don’t even like the term ‘information blocking,’” Tripathi admitted. “It was handed down to me in the law when I took on the National Coordinator role, so there’s nothing I can do about it. But I prefer to think in terms of information sharing and how we can enable that to improve the delivery of quality care.”

The ONC is focused on making the information blocking rule work well for an industry in flux, starting with releasing a benchmark report on the data sharing landscape at the beginning of the process.

In late February, the Office of the National Coordinator (ONC) published its first report on the information blocking claims received since April of 2021, emphasizing the ONC’s commitment to transparency and collaboration. 

“One of the most important things the government can do is provide information back to the market so they have good visibility into the issues and can act accordingly,” Tripathi said.

He explained that over 75 percent of the complaints were from patients, and 75 percent of the claims were against providers.

“I don’t know how much information blocking is really out there, but I don’t think most of it is malicious in nature. It’s more that providers are not prioritizing the sharing of information. It’s not high on the list, so they’re just doing the bare minimum to avoid penalties without really investing in making interoperability a core part of their business model.”

That strategy won’t be acceptable for long, he cautioned. “Minimum compliance has been a plague on our industry, and it will only lead to more and more regulation. It might stop you from getting fined for the moment, but it’s not a viable long-term solution.”

“We strongly urge you not to view regulation as the lowest bar to clear. We want you to build on top of the regulations to create something meaningful and follow the spirit of the law, not just the letter, so we can let the market lead us to where we want to go.”


Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry. Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.

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