This past January marked President Trump’s one-year anniversary. Although many of the healthcare headlines from the first year were characterized by partisanship and controversy, other important healthcare topics that received less press warrant attention, including health information technology (HIT) policy.
After a year in office, it’s possible to make two broad observations of the administration’s and Congress’ approach to HIT.
First, the Trump administration continues to advance many of the goals of the Obama and Bush years. These efforts include actions to accelerate consumer-directed data exchange and network-to-network interoperability as directed by the 21st Century Cures Act (Cures Act).
Second, although its HIT goals are similar to those of the Obama administration, the Trump administration has placed more emphasis on ways the private sector can help drive HIT efforts. The Office of the National Coordinator for Health Information Technology (ONC), for example, has a smaller staff than in previous years, which is likely the result of budget priorities and an effort to facilitate private sector expansion to further advances in HIT.
The Cures Act, passed in late 2016 with strong bipartisan support, established a vision for increased interoperability, strengthening consumers’ rights to access, use, and share their health data, and directing the ONC to develop a Trusted Exchange Framework and Common Agreement (TEFCA) to share health information across networks. The Cures Act also enacted stringent penalties for information blocking. However, it did not explicitly detail how to encourage interoperability or how to define information blocking, but rather directed the ONC to provide more specific guidance.
The Trump administration is focused on advancing a patient-centric healthcare system—a goal that also aligns with the mission of the CARIN Alliance (Creating Access to Real-time Information Now), which is a bipartisan, multisector collaborative convened by David Blumenthal, David Brailer, Aneesh Chopra, and former HHS Secretary Mike Leavitt. The CARIN Alliance consists of leading risk-bearing providers, payers, patients, health IT companies, and consumer-advocates that are collaborating with other stakeholders and leaders in government to overcome barriers in advancing consumer-directed exchange across the United States. Their vision is to move rapidly to an environment in which consumers and their authorized caregivers can easily obtain, use, and share their digital health information, thereby enabling them to achieve their goals when, where, and how they want to do so.
Specifically, the CARIN Alliance is promoting the ability of consumers and their authorized caregivers to gain digital access to their health information via the open application programming interfaces (APIs)—a requirement for the advancing-care-information measure provide patient access, set forth under the Merit-based Incentive Payment System (MIPS) established by the Medicare Access and CHIP Reauthorization Act of 2015. This measure requires providers to share electronic health information with any application the patient chooses.
Simply put, the alliance envisions a future where any patient can choose any application to retrieve his or her health information from any provider anywhere and at any time. We can expect to see further advances in consumer-directed data exchange to improve interoperability at HIMSS and throughout the remainder of 2018.
The ONC’s TEFCA
To add concrete detail to the goal of increased interoperability, on Jan. 5, 2018, the ONC released its draft version of TEFCA to promote interoperability among qualified health information networks (QHINs) by addressing two main challenges—first, that providers often must join multiple networks because one network does not share data with another, and second, that lack of network interoperability requires healthcare organizations to have several costly and burdensome interfaces with other organizations. QHINs will voluntarily participate in TEFCA and agree to abide by its requirements to facilitate data sharing between networks.
The ONC won’t oversee TEFCA alone. The role of coordinating and administering TEFCA will be a collaboration between the ONC and a private-sector entity called a Recognized Coordinating Entity selected through a competitive bidding process. This outsourcing of TEFCA oversight is consistent with other administration actions to rely more heavily on the private sector. The ONC is accepting comments on the TEFCA draft until Feb. 20, 2018, and a final draft is expected by the end of the year. a
The ONC Expected to Rule on Information Blocking
This spring, the ONC is expected to release a proposed rule on information blocking, which is the deliberate effort to impede the exchange of healthcare information. The Cures Act created heavy fines—$1 million per violation—for information blocking. There is still one problem: Not every instance of information blocking is intentional, or negative. Technological limitations or data challenges may seem to be information blocking, but in fact be real, albeit inadvertent, barriers to information exchange. Moreover, some information blocking may constitute legitimate efforts to comply with the HIPAA Privacy and Security Rules. The proposed rule is expected to clarify what does not constitute an information blocking violation. b
The Trump administration may still be finding the optimal balance between regulation and private sector innovation. An administration’s second year presents several unique opportunities. First, many of the learning curves of the first year are resolved. Second, there’s still enough time for regulations or other actions enacted in the second year to take effect during the president’s term.
In this second year, the Trump administration likely will become much more vocal in advocating for a patient-centric model for exchanging healthcare information and solving the problem of interoperability. Moreover, the administration and the VA likely will be promoting the value of API s and third-party application to enable consumers to gain access to their health information.
a. Morris, G., “Trusted Exchange Framework and Common Agreement: A Common Sense Approach to Achieving Health Information Interoperability,” Health IT Buzz, Jan. 5, 2018.
b. Tahir, D., “Info Blocking Rule Coming This Spring,” Politico Morning eHealth, Dec. 1, 2017,