Breaking Down the Federal Health IT Plan (2020-2025)

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Bill Russell / Seth Pazinski

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November 11, 2020: Seth Pazinski from the ONC for HIT joins us to flesh out the heart of the 2020-2025 Federal Health IT Strategic Plan. How can you get your hands on it? What’s the best way to use it? The plan’s mission is to improve the health and wellbeing of individuals and communities using technology and health information that is accessible when and where it matters most. Is there an underlying set of assumptions around the problems that we’re facing? Can the plan reduce current regulatory burdens? What does it mean for the individual to be first? And what expectations does it set for data sharing including privacy and security of information?

Key Points:

  • The six principles that underlie the plan’s strategy [00:05:51] 
  • Trusted Exchange Framework and Common Agreement (TEFCA) [00:08:36] 
  • Promote Health and Wellness and Enhance the Delivery and Experience of Care [00:08:55] 
  • One thing we focus on is improving access to smartphones and other technologies amongst at-risk minority, rural, disabled and tribal populations [00:15:10] 
  • Plans for aligning and coordinating efforts that focus on health disparities or social determinants [00:17:00] 
  • ONC did a specific strategy in response to a congressional requirement that was focused on provider burden reduction [00:20:05] 
  • It creates the opportunity for advancements and analytics including machine learning, artificial intelligence and the ability to forecast and have the potential to transform care and improve health [00:23:40] 
  • 2020-2025 Federal Health IT Strategic Plan

Breaking Down the Federal Health IT Plan (2020-2025) with Seth Pazinski

Episode 327: Transcript – November 11, 2020

This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

[00:00:00] Bill Russell: [00:00:00] Welcome to This Week in Health IT. Today, Seth Pazinski from the ONC for HIT joins us to discuss the 20, 20 to 2025 federal health IT strategic plan. My name is bill Russell, former healthcare CIO, CEO, coach consultant, and creator of this week in health. It. I said a podcast videos and collaboration events dedicated to developing the next generation of health leaders. Special thanks to Sirius healthcare for supporting the mission of our show [00:00:30] to develop the next generation of health leaders. We couldn’t do what we do without sponsors like Sirous. Now onto the show. 

[00:00:37] Alright at the ONC for Health Information technology has released its 20, 20 to 2025 federal health it strategic plan. And today we take a look at that with one of the people who pulled it together. Seth Pazinski the director of the strategic planning and coordination division of the ONC for health information technology, Seth, welcome to the show.

[00:00:58] Seth Pazinski: [00:00:58] Thanks [00:01:00] welcome. And thanks for having me on the show. 

[00:01:02] Bill Russell: [00:01:02] Yeah, I’m looking forward to it. This is an important strategic plan that covers five years and I’m really looking forward, to just, diving in, but I’d be remiss if I didn’t open with just one question on, tell us, people are thinking, Hey, 20, 20 to 25, 25, we just have a new administration. Tell us about the continuity of strategy and planning between, administrations and maybe over the years. 

[00:01:31] [00:01:30] Seth Pazinski: [00:01:31] Sure, thanks for the question. so while we can’t speculate on what happens from one administration to another, the strategic plan does provide a foundation for health IT for the federal government. And, just a reminder that the previous one. So strategic plan came out in 2015 and it helped the federal government take steps in advancing interoperability of health information. And the mission from that prior plan to this plan remains the same. To improve the health and wellbeing of [00:02:00] individuals and communities using technology and health information that is accessible when and where it matters most.

[00:02:06] And we’ve seen a lot of continuity and bipartisan support in the past. And in both of the significant legislations for ONC and that have shaped prior strategic plans and this one with the high-tech act and the 21st century cures act, we, the plan is, incorporates those legislations and sets that as [00:02:30] a key piece of the federal health IT strategy.

[00:02:33] Bill Russell: [00:02:33] Yeah and, we’re going to talk, we do talk a fair amount on this show about the 21st century cures act. And I think that it will be interesting to see that as a foundation, moving forward for how things are going to change. So let’s just dive into the strategic plan, but first, tell us about the process. How do you come up with a plan? What’s the process you go through for developing the plan?

[00:02:56] Seth Pazinski: [00:02:56] Sure the, the high-tech act is what [00:03:00] provides the statutory requirement for the office of national coordinator for health IT to maintain a federal health it strategy. And it also requires us to work in collaboration both with our public and private sector partners to develop the plan. So this plan was led by ONC, but was developed in collaboration with around 25 different federal organizations. We convene those federal partners, in a series of working sessions, to develop the initial draft. that [00:03:30] draft was put out for public comment. And during that public comment period we engaged our health information technology advisory committee, which is a federal advisory committee to the national coordinator, to provide us feedback on the plan.

[00:03:44] We also received nearly 100 public comment submissions as a part of the public comment process and all of that public input. All of that input from our federal partners is what helped to develop and shape the final plan that was released. 

[00:03:58] Bill Russell: [00:03:58] Is there, is there [00:04:00] an underlying set of assumptions around the problems that we’re facing that inform the plan from year to year?

[00:04:09] Seth Pazinski: [00:04:09] Yeah, the, there was, extensive background research to, done in order to provide the context and understanding for the development of the federal health it strategy. and in the plan, we focus on both the challenges within the current health care system. So broader context and just health IT specifically, but what are those things [00:04:30] happening in the healthcare industry, that kind of factor in health it, and then we also look at what are the opportunities in a digital health system, that are enabled or empowered because information is electronic and can be, access exchange and use for easily.

[00:04:46] So we look at things from the broader healthcare context, the increasing healthcare spending. We also look at increasing rates of mental illness and substance use disorders. And we look at the challenges to [00:05:00] both care and technology, as well as the ability to access exchanging news that electronic health information and within that broader healthcare context if you take a look at, okay, what are the opportunities in the digital health system? So empowering patients, that’s the foundation and one of the primary drivers with the federal health it strategy it’s providing access. To patients and individuals to their own health information. We also look at the continuing to move forward [00:05:30] and value based care, advancing interoperability of information, as well as promoting to new technologies and competition along with, the ability to reach, reduce regulatory administrative burden on clinicians. There’s a, some of the foundational pieces that we look at as our unique opportunity to digital health system. 

[00:05:51] Bill Russell: [00:05:51] Yeah. So you have six principles that underlie the strategy. I’m just going to run through them real quick and then I want to touch on them.

[00:05:58] So you put the individual [00:06:00] first focus on value, build a culture of secure access to health information, put research into action, encourage innovation and competition and be responsible. Be a responsible steward. Let’s start with the first one. This is the one that really stands out to me put the individual first, has really been a hallmark for quite some time, but it’s really been a hallmark of, the, verbiage that SEMA Burma has been talking about and secretaries are, [00:06:30] but really SEMA Burma has been out there talking about, the patient at the center of transparency and all those things. What does it mean? What does this strategy pull out. What does it mean for the individual to be first? What does that concept, but individual first mean. 

[00:06:48] Seth Pazinski: [00:06:48] So within the 20, 20 to 2025 federal health equity, strategic plan, the goals and objectives there are, at the at the top priority. And the number one aspect of that is [00:07:00] focusing on individuals getting access to their electronic health information. We see that as the foundation of putting patients first. It puts them that access to their information puts them in a better position to manage and control their health along with their health information. So that’s really the foundation of the plan and the foundation of the federal health it strategy and ONC in collaboration with our federal partners are focusing on those cross-cutting areas across the plan. That will promote modern [00:07:30] health IT for all stakeholders, as well as address those barriers to access exchange and use of electronic health information. Again, the choice to put, patients first on this list of our priorities was, intended to indicate that is our top priority. 

[00:07:49] You also have built a culture of secure access to health information. It’s not just taking it to the next level in terms of talking about the, the need for privacy and security [00:08:00] around, around the patient, accessing their information and the sharing of information. Certainly enclosed privacy insecurity. And I would say more broadly reflects the focus of one of the objectives within the federal health IT strategic plan is to set expectations for data, sharing those include privacy and security of information. and you can see that body than some of the, the policies that are coming out, within the 21st century cures act final rule from ONC, [00:08:30] for example, setting requirements around, privacy and security.

[00:08:36] And we anticipate that as well through programs like the trusted exchange framework and common agreement that we’ll continue to, establish those data sharing expectations for, the various stakeholders who, who are sharing information across networks. 

[00:08:52] Bill Russell: [00:08:52] All right. So you, introduce the four goals in the strategic plan framework, promote health and wellness, enhanced [00:09:00] delivery and experience of care, build a secure data-driven ecosystem to accelerate research and innovation and connect healthcare with health data. Let’s walk through these and I think this is, this really becomes down to the heart of the, plan and how it, if it gets fleshed out, promote health and wellness. What are some of the objectives that are supported, with health technology in this plan? 

[00:09:29] Seth Pazinski: [00:09:29] So it [00:09:30] is intentionally abroad, strategic plan, that reflects the various roles that federal agencies play within the healthcare and health it industry. And at first, and primary, when we began working with our federal partners, we want it to develop an outcomes, driven plan. So we were focused on who benefits. So as a result of the implementation of the strategy. You’ll see that we highlight a variety of stakeholders, including [00:10:00] patients and populations, caregivers, healthcare providers, payers, public health professionals and researchers and others, who really are the key groups that we hope in particular will benefit around the first three goals of the plan, promoting health and wellness which is around those patients, caregivers, populations enhancing the delivery and experience of care. So again, focused on patients there but also, how the stakeholders like healthcare providers and payers are engaged in the [00:10:30] system. The third goal is really around, researchers and innovators, developers around building that secure data driven ecosystem to accelerate research and innovation.

[00:10:41] And then the fourth goal really cross cuts the first three it’s around those, that policy and technical infrastructure that can support the other three goals and the organizations that we hope will benefit from those goals. And we have seen already some of the federal agencies, taking steps to, to build off of [00:11:00] this federal health IT strategy with, the federal electronic health record monitorization program office adopting the same goals in there. Interoperability, monetization strategy, supporting the department of defense and department of veterans affairs. And specifically around that, first go around promoting health and wellness. It’s really about, making sure that individuals have access to usable health information. Again. Continue to focus on that patient access piece. The second [00:11:30] part of that is about advancing healthy and safe practices through the use of health IT and then the third part is around integrating health and human services information. So we’re also taking a look at things like social determinants of health and how individuals can be supported outside of the traditional healthcare system. Those are some of the ways that we’re looking at, promoting health and wellness and using technology and health information to support individuals and populations. 

[00:11:56] Bill Russell: [00:11:56] All right. We’ll get back to our show in just a minute. I want to give you an update [00:12:00] on the clip notes referral program. For those of you who don’t know what clip notes is, what we have done is we create a summary of what goes on each show and we get that into your inbox 24 hours after the show airs. So what you get is a. Brief summary of the show. You get bullet points as to what the high points were with timestamps, and then you get one to four video clips. So if you just want to see that the highlights, the key moments of the show, you can just click, on those, watch those and stay current. we did that in [00:12:30] response to some of the things you guys were telling us, made it easier. Easier for you to, share the content of the show with your peers, with your staff, with, others. And it’s a great way for you to stay current, especially when you’re busy and you can’t listen to every episode. So we wanted to make sure that you have an easy way to stay up to date as to what’s going on in the show. As a result because you told us this is, has been such a great, service. We created a referral program because we want to get this in the hands of as many people as possible.

[00:12:58] And we can only do that through you. [00:13:00] And, so what we did is we said, all right, Let’s let’s do a competition. Everyone likes competition. So we, we came up with some prizes and some ways for you, to, refer this out to your friends, to your staff, to people within your organization. the prices are pretty straightforward. Everybody who does a single referral will be entered into a drawing to win a, work from home kit from this week in health. It, if you get up to 10 referrals, you get a black mole skin notebook delivered to you. Has this week in health, [00:13:30] it logo in Boston. It. I love the moleskin notebooks. I use them all the time. and then finally, the person who gets the most referrals will be given the opportunity to come on the show, to do a Tuesday news day episode with me. That’s the episodes that I usually do with Drex DeFord. and you are going to get invited to come on and talk about the news with me. It’s really straight forward. A lot of fun. it’s really conversational. We’ll have a great time doing it. And, I hope that you are excited about this as excited as I am to have people, [00:14:00] put your name in for a referral right now. If you go out onto our website, hit subscribe. there’s a new box in there. It says referred by if they put in your email address, you’ll be a credit for each referral that they put in there.

[00:14:11] We already have people that are approaching the moleskin notebook levels. So gotta keep pushing through. And we have, we’ve had just a ton of referrals to this point. So we really appreciate all that you guys are doing. And, we hope that the content is helping you to stay current and helping you to do your jobs more [00:14:30] effectively. With that in mind, let’s get back to the show. 

[00:14:34] Yeah I often say that this, show is the education of Bill Russell. And so you’re going to educate me on how the government works a little bit here. When you say things like improve individual access to usable health information, would the, would that inform like the FCC’s goal to increase access in rural and in remote communities, [00:15:00] to health as well as access to health information?

[00:15:06] Seth Pazinski: [00:15:06] Yeah. So for example. One of the, strategies that we focus on is improving access to smartphones and other technologies, and in particular, among at-risk minority, rural, disabled and tribal populations. And so there are various federal agencies that focus on, Specific populations that they serve and across those agencies, [00:15:30] as they pursue their missions and supporting those different populations, they’re leveraging, health information technology, as well as making sure that those individuals have access to information. So that’s a mix of things like, particularly what we’ve seen Haven during the, the COVID-19 pandemic is within, rural communities access to broadband access to telehealth. Those are ways that, leveraging technology to improve, access to [00:16:00] usable health information.

[00:16:02] Bill Russell: [00:16:02] That’s interesting. And it’s interesting how this gets used. So if I’m with a, another part of the federal government, and I’m, thinking about health disparities or social determinants I’m thinking anything regarding health and technology. I would refer to this plan and I might even adopt some of these plans some of these aspects as we’re developing our, goals and guidelines for moving [00:16:30] forward. Is that, how that works? 

[00:16:33] Seth Pazinski: [00:16:33] Yeah. So the there’s really four ways we focus on working with federal partners and how we would anticipate federal agencies using the plan. The first is to prioritize resources. So the plan is an opportunity for individual federal agencies whether it’s through the budget request or internal planning to look at what are the priorities that have been established as part of the federal health IT strategy. The second piece, which is a really big part is [00:17:00] around aligning and coordinating efforts. And I mentioned that, they are the, that we are seeing other agencies, for example, align their strategies to this federal health IT strategic plan.

[00:17:12] It’s also a way for us to coordinate across, the federal agencies that are engaged in, health IT which is numerous. and we can coordinate on things like standards. The federal government is actively working across our, partners and [00:17:30] ONC is facilitating that coordination around things like the FHIR standard, and how that can be expanded and used for a variety of federal health, federal health, it use cases across various agencies. So it’s a way, for example, two agencies to come together and align around common standards. it can also be used to signal priorities to the private sector. So while this is a federal plan and speaks to what the federal activities would be it also can be used as a communication to inform the private sector [00:18:00] what are the priorities of the federal agencies? And the last part is, it can also be used as a way to benchmark and assess progress. And so we are focused on within ONC and working with our federal partners around five cross-cutting areas that we think will help advance overall the goals of the strategic plan. That’s one, as I mentioned around promoting the use of the FHIR standard across federal organizations, [00:18:30] And also we’re looking at using secure standards-based outpatient programming interfaces to provide electronic health information. a third piece, again, another standards piece is around building off the US coordinator for interoperability standard that was established in ONC is 21st century cures act final rule. And using, building off that for additional data classes and elements that support federal use cases. And then the last few pieces that are around those [00:19:00] data sharing expectations. So the turning information blocking practices using federal authorities and investments.

[00:19:06] And then encouraging data exchange across networks, at both the national and community levels. So those are the things that as we look forward to implementing the plan, that’s what we’re anticipating from an ONC standpoint, focusing a lot of our coordination efforts with our federal partners. 

[00:19:22] Bill Russell: [00:19:22] It’s interesting, a lot of health systems are focused on, the experience and the delivery of care and you have a whole [00:19:30] section of this. I think I can talk the second. The second goal of this is enhancing the delivery and experience care. Talk about, and this is pretty extensive. you, cover, as you said earlier, you cover everything from research, to payers, to providers, and how people are able to utilize technology and the, burden sometimes it comes along with the technology. So talk a little bit about what you’re trying to achieve in the experience area [00:20:00] of the, plan. 

[00:20:03] Seth Pazinski: [00:20:03] The plan really and, ONC did a specific strategy in response to a congressional requirement that was focused on provider burden reduction. So this plan takes into account those specific, activities that are in recommendations that are, were described in, in that joint strategy from HHS on, reducing provider burden.

[00:20:29] It acknowledges that [00:20:30] clinician space, a significant amount of time entering data, and other documentation and EHR is for reimbursement purposes, quality, public health registry reporting, prior authorization. So it looks at how we can do things like simplify and streamline documentation. Promote the use of evidence-based automated tools, as well as streamlined processes to reduce the level of effort for healthcare providers and health systems in responding to those federal [00:21:00] requirements. So LNP is actively engaged in on those pieces. And for example, we’re currently working with our health IT advisory committee. In a task force, that’s focused on the intersection of clinical and administrative data, looking for efficiencies and how we can merge those data for purposes of, improving the prior authorization experience.

[00:21:22] So we’re actually looking forward to getting recommendations from our federal advisory committee, later this year on, [00:21:30] what would be some recommendations and activities that, ONC and federal partners can take, to address those aspects of, clinician burden. 

[00:21:39] Bill Russell: [00:21:39] So could that lead to a reduction in the regulatory burden in some way or a reduction in the, the, way we report or the number of data elements or those kinds of things. Is that what that potentially leads to. 

[00:21:54] Seth Pazinski: [00:21:54] And that would be, that’s the intent of the, the objective within the plan is to reduce that [00:22:00] regulatory administrative burden to taking those administrative requirements and allowing clinicians to have more time with their patients, and have a better overall experience, with delivering health care. And again, ONC put out an entire strategy, focused on recommendations there for both ourselves and some of our federal partners and we’re are working to take steps against that strategy. 

[00:22:24] Bill Russell: [00:22:24] So, you talked about the data-driven ecosystem and on this show, we focus on [00:22:30] an awful lot on provider to provider sharing. And we talk a little bit about provider and payer sharing, but this has a broader aspect to it of pulling in data. obviously our health is more than just our visits to the healthcare system. Our health is about the individual decisions we make, where we live, the disparities. There’s a lot of different aspects that come into it, which sometimes just gets lumped under social determinants. But [00:23:00] there’s a lot of different data sources out there. Talk about maybe the, concept or the, vision for, how we, expect to bring all the different data elements, to bear on the health of population.

[00:23:17] Seth Pazinski: [00:23:17] Yeah. So we talked about an integrative, integrated ecosystem. and that is one that respects privacy and security, as far as the collection of information, but also focuses on collecting data from [00:23:30] multiple sources to unlock the power of that information. And so with access to data and technology, it creates the opportunity for advancements and analytics so things like machine learning and artificial intelligence and the ability to forecast, and have the potential to transform care and improve health. And those are some of the key aspects of this goal. both in accelerating research. Accelerating innovation, but also then, reducing the time and [00:24:00] it takes to translate that learning into decisions that at the bedside.

[00:24:05] So furthering provider access to data stored in EHR and apps, and in particular leveraging secure standard space, outpatient programming interfaces to empower individuals, providers, payers, public health researchers, all those stakeholders, In, the ability to both collect that information and then, use it to gain knowledge and learning and healthcare, 

[00:24:31] [00:24:30] Bill Russell: [00:24:31] There’s an awful lot of innovation coming down the pike. We have AI, machine learning. We have, FHIR opening up access to data stores. we have, new entrance and new players. We have big tech coming into healthcare. The thing about this is it, really. It, again, patient first or, I’m going to get the wording wrong. The individual first, [00:25:00] You’re looking to create a framework where technology is used to provide the best care to an individual or best care to a population. It doesn’t really necessarily favor a provider or a payer or a researcher or big tech or pharma. It just provides, a framework for how technology can be used, for those people. That’s how I’m reading that. Is that, essentially, or am I missing the mark a little bit there? 

[00:25:28] Seth Pazinski: [00:25:28] No, that’s the key part of our [00:25:30] focus and our messaging really is about promoting modern health IT for all stakeholders. So you heard, me speak earlier about the variety of stakeholders engaged here, and it does go from patients to healthcare providers, researchers, public health payers, really all benefiting from having appropriate access exchange and abuse of health information. and going back to some of the points that we emphasize for ONC collaboration and coordination purposes with our federal partners, it is [00:26:00] some of those technical pieces that broadly support stakeholders like providing access through the secure standard space application programming interfaces, as far as accessing both, individual patient information, but also information at a population level. it focuses on common standards, so that we’re building off of the fire, standard and supporting various use cases and the various populations that federal agency serve. Same thing [00:26:30] with the U S coordinator for interoperability, which gets down to those data elements and classes, to improve interoperability and making sure that they can support a variety of federal use cases and populations.

[00:26:42] And then the last piece that, really it’s about the, that what’s that expectation for data sharing so that, data does appropriately follow and go to where it needs to be. And that’s around making sure that we’re deterring information, blocking practices and encouraging that appropriate data [00:27:00] exchange across networks, both at the national and community level.

[00:27:05] Bill Russell: [00:27:05] Well Seth this is great work and I really appreciate you coming on the show to share it, with us. How can people, get, access to this? I downloaded it off the website. Is that the best place for people to go? Where would they go to get the report?

[00:27:26] Seth Pazinski: [00:27:26] Yeah healthit.gov is where the [00:27:30] report’s located. and I’ll also say that as far as tracking how this progresses in the future, we will again be looking at some of those cross cutting technical and policy pieces that we think will help support and, benefit the individuals that we’ve found that we’ve mentioned so far, and ONC publishes an annual report which is submitted to Congress that talks about, what is the current state of health IT and the industry that’s also available in health it.gov. [00:28:00] The last version of that was put out, in early 2019. So the next update to that report to Congress that lays out what are the, persisting barriers, what are the actions being taken by federal agencies and what are our recommended paths going forward? We’ll continue to communicate through that report.

[00:28:19] Again that’s available on healthit.gov as well. And we see that, we intend to align that report to, The our primary way that we’re [00:28:30] communicating progress against the federal health I teach strategy. so both, accessing the plan, as well as keeping track of how things are progressing, encourage folks to go to health it.gov and check out those resources 

[00:28:43] Bill Russell: [00:28:43] It really is a well laid out site. It’s pretty easy to find. October 30th, the news, federal health IT strategic plan supports patient access to their own health. And then there’s some like right there. You can also get it off the blog as well. And actually it’s just a really well [00:29:00] easy to, navigate a website for those who are wondering, government websites, easy to navigate this one is, fairly, fairly easy, has a ton of great information. Again, Seth thanks for coming on the show. I really appreciate it. 

[00:29:17] Seth Pazinski: [00:29:17] Thanks for having me and thanks for the opportunity to talk about the federal health equity strategic plan. Really appreciate it. 

[00:29:23] Bill Russell: [00:29:23] That’s all for this week. Special thanks to our channel sponsors, VMware, Starbridge Advisors, Galen Healthcare, Health Lyrics, Sirius Healthcare, [00:29:30] Pro Talent Advisors, HealthNXT and McAfee for choosing to invest in developing the next generation of health leaders. We really appreciate their support. Don’t forget to sign up for clip notes. Send an email, hit the website. We want to make you and your system more productive. This show is a production of this week in health IT.  For more great content check out the website this weekhealth.com. Check out our YouTube channel. We continue to modify that and make that better and easier to find things that you are looking for there. Please check back every Tuesday we do news day. Every [00:30:00] Wednesday, we try to do a solution showcase every Friday. We do interviews with industry influencers and we will continue to do that through the end of the year. And then we have some interesting things lined up for the new year. And I can’t wait to share those with you and we will start sharing those with you here shortly. thanks for listening. That’s all for now.