All the Tools in the Toolbox: How ONC Delivered Value In 2012

Dr. Farzad MostashariFarzad Mostashari, MD, National Coordinator for Health Information Technology
Twitter: @Farzad_ONC
A recent story characterized the Office of the National Coordinator for Health IT (ONC) as both “the federal office in charge of a massive rollout of electronic health records” as well as “an office whose primary role has been cheerleader” for health information technology. Well, which is it?

To be fair, since David Brailer’s time, the National Coordinator for Health IT has had two distinct roles:

  1. Representative and giver-of-cheer to a diverse community of technology developers and implementers, patient advocates and entrepreneurs, policymakers, and clinicians who are all bound together by their conviction that health and health care can be made better through the use of information technology
  2. Director of a federal agency with certain authorities, duties and resources—and a team of passionate and dedicated public servants.

Today, as in last year’s New Year blog post, I will share with you a few of the ways—that go beyond cheerleading—in which ONC has interacted with you to meet its mission and mandate over the past year.


ONC as a Regulator

Together with our partners at the Centers for Medicare & Medicaid Services (CMS), we define the policies and issue the rules that govern:

  • Certified Electronic Health Records (EHRs),
  • Meaningful use, and
  • Billions of dollars in health IT incentives.

Stage 1 is off to a terrific start with 84% of eligible hospitals registered and 68% paid, and 64% of eligible providers registered and 33% paid to date.

The final rules released in August for Stage 2 of Meaningful Use advance patient safety, population health, and patient engagement, but most critically make possible a giant leap for secure interoperability and exchange. Through our terrific Federal Advisory Committees—which are among the most open and accessible in the federal government—we listen to you, synthesize the essence of your concerns/input/advice, and come up with practical solutions to achieve the most meaningful use of Meaningful Use.

Technical Assistance & Cooperative Agreements

The Regional Extension Centers (RECs) continue their work to support primary care providers operating in small or medically underserved settings to implement EHR systems and achieve Meaningful Use. To date, the RECs have worked with 132,842 primary care providers in more than 31,000 different practices, which represents approximately 42% of all the primary care providers in the United States.

The RECs have also worked with over 80% of all the federally qualified health centers and over 70% of the nation’s critical access hospitals. More than 100,000 of these providers are now live on an EHR system and nearly 40,000 have achieved Meaningful Use.

Targeted Investments

With support from CMS, we have worked with quality measure developers to continuously improve the process by which clinical quality measures are developed, endorsed, and selected. ONC also  partnered with CMS to align quality measures across Meaningful Use and other federal programs.  We have also started important work that will help clinicians and patients incorporate evidence-based guidelines into their work, since an effective clinical quality measure improvement program is a combination of tools such as clinical decision support and quality measurement.

Open Data

ONC strives to be as transparent in our work as possible.

Our monthly data file of Meaningful Use attestation and certification information is downloaded by thousands of users. I am excited about the enhancements that we have continued to make to the ONC Dashboard where users can track Meaningful Use by state (which includes 50,000 data points and downloadable data sets), information about RECs, and much more. We also work with the CDC Center for National Health Statistics’ National Health Care Surveys and provide survey support to the annual adoption scorecard.

Challenging (and, OK, Cheerleading)

At last year’s annual ONC meeting, we challenged states to set ambitious targets for Meaningful Use acceleration. This year, we trumpeted the success of our State partners in the Meaningful Use Acceleration challenge, where a number of states— led by Maine, Ohio, and Kentucky—showed that they had made Meaningful Use a foundational building block for delivering better coordinated care, lowering health care costs, and improving patient health.

Creating “Destination Postcards” From the Future

Our 17 Beacon Communities are demonstrating early results around better outcomes for patients with chronic disease, better care for at-risk populations, and reductions in unnecessary utilization of services. The Colorado, Oklahoma, and Cincinnati Beacons are also supporting innovative payment models through the Comprehensive Primary Care Initiative at the Center for Medicare & Medicaid Innovation. In 2013, Beacon Communities will continue to prove that health IT enables and fosters critical changes in where and how we deliver health care.

2. Exchange & Interoperability

ONC as an Impatient Convener

Through the Standards & Interoperability Framework, ONC takes every opportunity to bring together hundreds of dedicated health IT stakeholders to work iteratively and swiftly in helping develop and harmonize standards and specifications that support interoperable health information exchange. (Last year’s meetings were held every 3.5 hours on average across the 10 standards and interoperability initiatives.)

In 2012, we worked closely with our partners in the Federal Health Architecture (FHA) to guide the strategic alignment of health IT and interoperability across the Federal programs, and in coordinating the development of the CONNECT open source gateway.

ONC as a Judicious Non-Regulator

Late last year I wrote that ONC had decided to support existing non-regulatory governance mechanisms for the nationwide health information network rather than pursue rulemaking. This was a tough call, but after getting frank feedback from many stakeholders, we were convinced it would be smarter to launch a range of activities to support existing governance initiatives that are working toward increased interoperability, decreased cost and complexity of exchange, and increased trust among participants. Deciding what not to do is not easy- I once heard this called “Zen and the Art of Government.”

Piloting New Ideas

We help on-the-ground implementers package together the technical and policy building blocks to solve the most pressing care delivery challenges. For example, our state HIE grantees are implementing pilot projects across the country (for example, in Maryland, Oklahoma, Massachusetts and Colorado) to identify the best workflow and technology interventions to support information exchange as patients transition from the hospital to long-term and post-acute settings (LTPAC).

These efforts address an important quality and efficiency problem in patient care. One in five Medicare enrollees is readmitted within 30 days of hospital discharge, in part due to care coordination issues once patients return home. The pilots are supported by standards development to identify the data sets that will support the care needs of LTPAC providers. ONC’s pilot and standards efforts, along with new payment and care delivery systems, are jumpstarting the broader inclusion of LTPAC providers in exchange efforts across the nation.

3. The Consumer Space

ONC’s  “Calls to Action

Few of our calls to action have been as successful as the Blue Button initiative. This concept, pioneered by the U.S. Department of Veterans Affairs (VA), gives people secure online downloads of their health information. We launched a pledge drive to ask data holders to make it easier for patients to get their own data. By the end of the year, 88 million people had gained access as Blue Button became available through the Medicare Program at, national health plans, and the 450 member companies of the Pledge Program. These pledges include the American Nursing Association, which launched its own “Ask for Your e-Health Records Week” campaign to encourage nurses nationwide to ask for a copy of their records.

Prizes and Awards

ONC’s Investing in Innovation program helps the software development community focus their attention on areas that are ripe for innovation and key to achieving better health IT. Our Health Design Challenge sprang from this effort. We asked designers to re-imagine the patient’s health record to make it more accessible and usable. The result: a whopping 233 submissions. We just announced the winners in a variety of categories including best overall design.

4. Patient Safety

Federal Coordination

Every day, we work in partnership with a veritable alphabet soup of federal agencies (AHRQ, CDC, CMS, DOL, FCC, FDA, FTC, HRSA, NIH, NIST, OCR, SSA, USDA, and VA to name a few) on a range of issues to align policies and resources for the benefit of patients and the health IT community.

One good example is HHS’s draft Health IT Safety Plan, which addresses recommendations issued by the Institute of Medicine to improve health care safety in general, and health IT in particular. Working with AHRQ and CMS, we crafted a comprehensive plan that calls on each agency to contribute uniquely to the strengthening of patient safety in health IT.

ONC will use the certification program to work with vendors on improving software design processes and transparency; AHRQ will encourage more and better adverse event reporting to Patient Safety Organizations via the standardized Common Formats; and CMS will use its survey and cert authorities to identify and mitigate unsafe practices associated with health IT implementations in the field.

Bully Pulpit

The Safety Plan also calls on vendors to create an enforceable code of conduct that would commit them to sharing responsibility for patient safety. ONC recommended that developers put business practices into place to promote the usability and safe design of health IT products, and that developers work with Patient Safety Organizations and providers to assist in the reporting and analysis of health-IT safety events (comments on the Safety Plan are due to by February 4, 2013).

5. Privacy and Security

Baking privacy and security into everything we doregulations; RECs; guidance; convening; coordination.

Of particular note this year, we focused on privacy and security risks associated with mobile devices.  Health care providers have been rapidly adopting mobile technology (like smartphones and tablets) without adequate privacy and security protections in place.

ONC, working with the HHS Office for Civil Rights, rapidly developed and launched a mobile device privacy and security portfolio.  We built into our criteria for certified EHRs security requirements for automated encryption on end use devices that store identifiable health information. Within nine months we gathered information from stakeholders, identified good practices, and developed and released educational videos, FAQs, and other user-friendly materials explaining the steps health care providers can take to protect and secure patient health information when using mobile devices.

We have also produced a very successful Privacy and Security training game to help doctors, clinics, and hospitals understand where the chinks in their armor are.

In Summary

2012 was another banner year for health IT. All this and much more was accomplished by a relatively small number of dedicated public servants in partnership with you, using all the tools in the toolbox, and I couldn’t be more proud. We’re excited to keep forging ahead in 2013 and I look forward to hearing from you!

Farzad Mostashari, MD is National Coordinator for Health Information Technology. He blogs at Health IT Buzz, where this artical was originally published. Follow him on Twitter, @Farzad_ONC.