Inactive

The 21st Century Cures Act (Cures Act), enacted in 2016, has a number of health IT provisions that are being developed and implemented to address various barriers to health information exchange that i... The 21st Century Cures Act (Cures Act), enacted in 2016, has a number of health IT provisions that are being developed and implemented to address various barriers to health information exchange that intersect with health information exchange organizations (HIOs). Health information exchange organizations, which provide both the technical infrastructure and governance to enable exchange, have worked with a diverse set of stakeholders in their communities, whether at the local, state or regional level. A number of studies have found the use of health information exchange organizations (HIOs) is significantly associated with greater exchange and interoperability in hospital settings. Currently, health care providers may have to join multiple networks in order to exchange with their referral partners as limited exchange is occurring across networks. A key aspect of the health IT provisions of the Cures Act is to implement a trusted exchange framework and common agreement that will enable exchange across disparate health information exchange networks. Qualified Health Information Networks (QHINs) shall connect to each other once they join the TEFCA; their participants (including health information exchange organizations) will then be able to share information across participating QHINs. Assessing the early implementation of the TEFCA and its perceived effect on information exchange organizations’ role in facilitate exchange will be important to guiding ONC policy. Another key aspect of the Cures Act is to address information blocking, a practice that “is likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information.” According to the Cures Act, health care providers and technology vendors shall be penalized for these actions. While complaints and penalties can be tracked to monitor information blocking, these would likely capture only the most egregious cases. Broader information that captures the types and overall prevalence of information blocking can help guide the implementation of the regulation and assess the impact on the overall market. In a 2015 report to Congress, ONC identified information blocking on the part of vendors or providers as a potential barrier to interoperability. The report noted that there is little information currently available on the extent to which this is occurring; however, that “to fill these gaps, ONC is considering additional sources of data from key entities that enable health information exchange and interoperability, such as health information exchange entities (HIEs), health information service providers (HISPs) and health information technology (IT) developers (p.20).” Health information exchange organizations (HIOs) are in a unique position to share their insights on information blocking as they work closely with both health care providers and technology vendors in facilitating exchange for their community. In addition to implementing health IT provisions of the Cures Act, other key elements aspects of ONC’s work relate to promoting the use of established interoperability standards and implementation specifications to facilitate electronic exchange of health information. ONC updates and maintains the interoperability standards advisory (ISA), which serves as a guide to industry regarding the use of standards to support specific clinical health IT interoperability needs. ONC needs data on how well standards are conforming and used to make updates to its Interoperability Standards Advisory. The usage and conformance of standards is another critical area that ONC must measure. Again, given their unique role in working closely with both health care providers and technology vendors, HIOs can provide insights into the implementation and use of standards to facilitate exchange. As noted, HIOs are in a position to provide useful perspectives on ONC’s work related to implementing the health IT provisions of the Cures Act and advancing the use of recognized standards. Additionally, continuing to understand the evolving role of HIOs is critical. Studies published in Health Affairs show that HIOs lack sustainable sources of funding to support the services they provide. Understanding their continued role in advancing exchange and interoperability will be important, as they have demonstrated their value to be a critical enabler of health information exchange and interoperability. For example, HIOs are also providing services to support their communities during the COVID-19 pandemic. Examining these emergent areas is also important.