ONC Leaders Address Audience Concerns During Town Hall

In the seventh week of her tenure, Karen DeSalvo, M.D., new national coordinator of health IT, kicked off the ONC Town Hall talking about interoperability, stressing that it is about more than just IT. "One possibility," said DeSalvo, "is having the patient share the information. We're using every lever that we have to remind folks that it's the patient's—not the provider's—data."

But the session really started buzzing when members of the audience began to ask a panel of ONC leaders—including Jacob Reider, M.D., chief medical officer; Doug Fridsma, M.D., chief science officer and director, office of science and technology; and Judy Murphy, R.N., deputy national coordinator for programs and policy—about industry-wide issues as well as more specific challenges relating to their own organizations. 

One of the first questions of the town hall was asked by a radiologist who showed concern in reimbursement cuts neutralizing the impact from meaningful use incentive dollars. "If there’s a rise in the cost of care, I don't know where it's going, because it's not coming to us," the radiologist said. 

When asked about possible solutions ONC could bring to the radiology field to offset these cuts, Fridsma  and Kelly Cronin, healthcare reform coordinator, advised to reinforce DICOM standards through accreditation for image sharing between imaging centers and hospitals. "Experimentation has been done that is replicable," said Cronin, urging those who are struggling to look at those who are progressing. 

A later question from a consultant in Washington, D.C. asked if there has been any coordination between ONC and Congress to accelerate the results of the Health Information Technology for Economic and Clinical Health (HITECH) act, to which DeSalvo responded, "I don't have any rabbits to pull out of a hat here." She then expanded her response to include that ONC is in the process of its five-year evaluation (as part of the 2009 HITECH Act), and while Congress is quite interested in interoperability, more help and input is needed from the private sector. DeSalvo added that ONC will release some data in the coming week on the impact of the HITECH Act, five years in. 

To that end, perhaps the biggest frustration expressed by attendees had to do with electronic health record (EHR) interoperability, specifically as it pertains to health information exchanges (HIEs). Concerning this issue, Fridsma said, "Culture will trump strategy every time."

Regarding meaningful use and clearing up some confusion,  ONC officials stressed that its final rule released last week addresses EHR certification, not Stage 3. The Stage 3 final rule is due later this year, they said. Jodi Daniel, director, office of policy and planning, did say however, that the notice does contain a lot of questions soliciting feedback about Stage 3.

And when asked by a member of a Kentucky regional extension center about any effort to align all of the regulatory requirements on physicians, (ICD-10, meaningful use, PQRS, etc.), more than one ONC official said that Stage 3 may provide an opportunity to harmonize some of these regulatory initiatives. "That is something that HHS is working on—harmonizing its various programs to create a more seamless and streamlined way to capture the information," DeSalvo said. 

“Those are concepts you are going to hear a lot from us,” DeSalvo said. “We are just beginning to seriously evaluate our expectations. And Stage 3 is about balancing expectations with burdens."