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Commemorating the 20th anniversary of the Office of the National Coordinator for Health Information Technology (ONC). The episode revisits key milestones and initiatives from the ONC's inception in 2004 by executive order of President George W. Bush to its recent accomplishments. Topics include the High Tech Act, the evolution of health IT infrastructure, the significance of electronic health records, and the challenges faced in achieving interoperability. Bill reflects on what worked, what didn’t, and the lessons learned for the future, particularly in the context of AI and healthcare technology. The episode also highlights various strategic plans and legislation, such as the 21st Century Cures Act, which have shaped the healthcare IT landscape.

00:00 Introduction and Overview

00:59 The Birth of ONC

03:03 Early Challenges and Investments

04:01 The High-Tech Act and Its Impact

05:28 Advancements and Unintended Consequences

10:48 Strategic Plans and Final Rules

12:11 Recent Developments and Future Directions

13:14 Conclusion and Reflections


 Today. It, we're going to take a look at the ONC through history is their 20 year anniversary. And we're going to. I don't know. We're just going to look at historically what they've been able to do. And maybe have a few comments on that. My name is bill Russell. I'm a former CIO for a 16 hospital system in creative.

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All right today, we're going to look at the ONC and the history of the ONC 20 years ago in April. The office of national coordinator for health, it was created by executive order 1, 3, 3, 3, 5. I'm sure you needed to know that if in case there's ever an ONC trivia game. You'll know that answer. It was signed into existence by president George W.

Bush. In April, 2004, as we said I want to see you. Established within the department of health and human services, HHS and charged with fulfilling its responsibilities, consistent with a vision of developing a nationwide interoperable health information technology infrastructure. Think back to 2004. Man, it's hard to think back to 2004 were coming out of the Y2K stuff.

I guess AOL is still around and that's an on-ramp for a lot of people. To get onto the information super highway or the internet. And it's very It's very early on. I wouldn't say early on in the technology cycle because the technology cycle had developed pretty rapidly and a lot of other industries, but in healthcare, My gosh, 2004 was the age of paper. It was paper, it was clipboards.

It was fill this out. We'll put it on a chart. We'll put a bunch of stickies on it and we will put it into this special room for you. When you come back to visit us again, sometime in the future. God forbid you go to a different health system. In which case we have to take all those papers and somehow get those papers. From one hospital system to another hospital system where they will recreate that entire record, put it on paper, put those same stickies on it and put it into their room.

If you go to a third system, we repeat. And so that's what we were looking at back in 2004. And when the federal government looked at this, they said, my gosh, If healthcare isn't going to self-select technology on their own. We've got to do something to help to foster this and push it forward. So the office of national coordinator for health, it is birthed 2005 multimillion dollar investments in health.

It. The ONC has often looked for partnerships. And public private to drive things forward. And so they made some investments to bring people into the effort. 2008, saw the federal health it strategic plan or 2008 through 2012. We should go back and look at that. At some point, I should pull that up. And see what it actually said.

Sometimes looking at history. Will lead you as you prepare for the future. Like that plan, that there might be a good plan to look at if you're thinking about how we approach AI, because right now we might be making either the same mistakes. Or we could be learning from that health it strategic plan from eight to 12 and say, Hey, some of these things worked, some of these things did,

so sometimes going to look at. Then you had the high tech act. Hard for me to say, I always want to put a T at the end of high-tech. Hi tech. Anyway, it's the high tech act health information technology. For economic and clinical health high-tech act sought to modernize the healthcare system through widespread adoption.

And here's the bad word, meaningful use of health information technology. Listen to these goals to ultimately improve health care quality. Which it has done, we can argue. And I have argued with physicians over this, but it has improved quality and there's many cases of that. Reduced costs. That one, we can definitely argue. I'm not sure which side I'm going to fall on that one. Reduce costs and empower patients to take more act.

And we could argue that one too. Has. As technology really empowered patients. I don't know, reduce costs. I don't know. Improve quality. I think we can make that case. To take a more active role in their healthcare. The high tech act. Also importantly, established ONC in law and provides HSS with the authority to improve healthcare through health.

It, so this is where really, where things start to take off money, starts to flow. We have carrots and sticks for health systems that adopt. An EHR as a platform technology for. The medical record and sticks penalties for those who choose not to. And so we hit down this path and modernizing American healthcare.

Now we're in 2010 high-tech programs under the high tech act ONC. Launched several programs aimed at supporting nationwide implementation of health. It from different angles. These include the state health information exchange, cooperative agreement program that established health information exchanges in each state, regional extension centers that help to support small providers, health, it adoption beacon communities that demonstrated how health it advanced healthcare and workforce. Development program that provided health it education. To medical professionals, notably the strategic health.

It. Advanced research project sharp program supported the discovery of breakthrough research that led to the creation. Of the fast healthcare, interoperability resources, fire application programming interface. Focus standards that is enabling interoperable. Interoperability around the country. So couple things they did here again. A lot of times it's you don't know what you don't know until you start doing it. And so we implemented these, the state health information exchanges and. And it provided this meshed framework for sharing information locally, which is really important locally or regionally, which is really important.

And I really could make a case. It's the most important sharing of information is local and regionally because invariably, if you're going to a health system, one health system, and there's a specialty that they don't have, and they're going to send you to another, they're going to do that regionally. At least today.

That's what happens in a majority of cases. You're moving around regionally. I know that there's other cases there's complex. Complex cases where you're traveling from state to state. And whatnot, but those state and regional at the time of 2010. Made some sense to put in place. Now, what we found is that keeping the funding, which one thing to stand them up with funding.

It's another thing to keep them operating with funding. And that became a significant challenge. The other thing that became a significant challenge was helping them to be effective. That is the information coming in from all these various sources. We're not standardized, so we didn't have standard information.

So when it came in. Garbage in, garbage out. We had trouble creating this comprehensive our longitudinal patient record, if you will, but this comprehensive patient record, at least at a regional level. So you keep progressing this forward to trying to do it on a national level and you realize, wow, this this program, maybe wasn't as well conceived as it could have been, a national program may not have been received real well back then. Times change people. You know that the time. At which things happen does matter. And it does speak to why certain approaches are taken versus others. Advancing electronic health records, ONC health it certification. And start a meaningful use happens also this timeframe that's 2010 standard and interoperability framework.

S and I framework. I want to see you launch the SSI framework as a vehicle to convene the health. It community rapidly prioritize health, it challenges and subsequently develop and harmonized standards. Special specifications. And implementation guidance. To solve those challenges. Oh, and C was also responsible for curating the set of standards and specifications that support interoperability in short, that they can assemble into solutions for a variety of health information exchange areas. Okay.

So these are all the things that are happening around you. The thing that happened in MOU was unintended consequences. Yeah, people sprint off and make the money, but did not think about the long-term impact. Of the EHR and the decisions they were making around building the EHR and the data standards.

We did not put data governance in place prior to doing this. And therefore we ended up. With a mess. So there's a bunch of unintended consequences. With regard to how we implemented this technology there was also unintended consequences. There was fraud, quite frankly, there was a mass. There was a ton of anytime there's a ton of government money that flows out.

There's the potential for fraud that needs to be taken into account and a bunch of EHR. That came into existence to rake in the meaningful use dollars did not live up to the. Let's say standards that were required. Either for their health systems that they were serving or for themselves. And so there was much not lawsuits, but there's a bunch of fines that were levied much later. But they were levied nonetheless. I think there's some other unintended consequences in this, a, probably a clinical somebody with a clinical background with an MD. And their title could talk more specifically to these, but over the years you heard of. Various things that. Quite frankly. From a clinical setting. We added an awful lot of burden onto the the clinical staff. Cognitive load was increased. On the clinical staff, making them more prone to make mistakes. Because there was so much documentation, some of the other things that they had to worry about, plus we had to train them. All on these systems.

So there was an awful lot of a load from that perspective. Anyway. Did you, so you get the idea. 2011 federal health, it strategic plan, 2011 through 2015. Again, good to take a look at some of these things. See what we learned. What worked, what didn't work? 2014 edition final rule. So 2014 edition, final rule adopted. Important certification criteria that the hand standards based exchange promoted, EHR safety and security. Enabled greater patient engagement, introduced greater transparency and reduce regulatory burden. Maybe not to the extent that we would have liked, but that was the final rule, 2014 10-year vision to achieve interoperable healthcare infrastructure.

So in 2014 that, Hey, we're at the end of this. So this 10-year vision. Would be interesting to look at as well. The oldest, these 10-year vision for interoperable health, it infrastructure aim to improve information exchange among healthcare providers, enhancing care coordination and patient outcomes. It provided a roadmap for stakeholders to work towards a more connected. And efficient healthcare system, fostering innovation and collaboration in the industry. So that was the 10-year vision.

How are we doing? How have we done? If you look at this, there's an awful lot of things that worked and did not work. Shared nationwide interoperability roadmap was released in 2015. You had the federal it strategic plan in 2015 to 20, 20, 20 15. You had the information blocking report to Congress. Which of course leads to the 20 16, 20 first century cures act. We had an awful lot of things that transpired from 2016 to 2020, but we finally have the cures act final rule that was published in 2020. And now we get to today's interoperability framework, which is Tesco that gets published in 2022.

The first Q Hinz get established in 2023. And we began implementing Teka and what are they doing now? There's a lot of things are doing now. They have the common agreement, 2.0. Is coming out and then they have the HTI. final rule implementation provisions for the 21st century cures act. It makes updates to the ONC health it certification program for algorithm transparency.

So we're looking at algorithm transparency and the age of AI. And governance around that. So a lot of things happening in the ONC. I would love it to review some of those things. I might go back and take a look at them and see, what did we learn? And what's in those provisions. And have we learned, especially as we go into AI, Have we do we have the right foundation set? All right. That's all for today.

Happy anniversary ONC. Don't forget, share this podcast with a friend or colleague, you use it as foundation for mentoring. We want to thank our channel sponsors who are investing in our mission to develop the next generation of health leaders. Notable service now interprise health. Parlance certified health. and 📍 Panda health.

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