21st Century Cures Act Shows Bipartisan Support for Advancing Health IT

21st Century Cures Act Shows Bipartisan Support for Advancing Health IT

Tucked away in the bipartisan 21st Century Cures Act, just passed by both chambers of Congress and ready for President Obama’s signature, is legislation that could have a profound impact on the drive for more widespread interoperability of electronic health record systems (EHRs). Recognizing how critical the sharing of data stored in EHRs is to the Cancer Moonshot and Precision Medicine initiatives – both initially funded by this legislation – lawmakers included several significant provisions that are intended to push EHR system interoperability in a more focused, sustainable direction. Reinforcing the Office of the National Coordinator for Health Information Technology’s (ONC) already-stated commitment to interoperability, the Act directs the ONC to make the adoption of standards-based interoperability a priority by focusing on existing standards – specifically charging ONC’s HIT Policy Committee with making policy recommendations on standards and eliminating the HIT Standards Committee. The Act explicitly prohibits the HIT Policy Committee from going beyond making recommendations on standards; involvement in standard development is not allowed. These directives display an emphatic nod of support and boost to standards development organizations such as the Health Level 7, and NCPDP.

The legislation goes a step further by putting the health care industry on notice that the pernicious practice of information blocking will not get in the way of expanding the exchange of EHR data. The Office of the Inspector General in the DHHS will have the authority to investigate cases of information blocking and penalize entities found to be parties to restricting authorized and legal access to electronic health information.

Another interoperability provision may also signal the real movement of Congress in supporting a mechanism for uniquely identifying patients and correctly matching their disparate EHRs. Likely in response to mounting pressure from various groups including the National Patient Safety Foundation and the College of Health Information Management Executives, the GAO is charged with analyzing patient matching implementations and making recommendations to the DHHS.  

To deliver the open exchange of electronic health information that Congress is looking for, more research is urgently needed to determine what existing data format, semantic, and transport standards are gaining the most traction and why. Which standards are delivering tangible value that if deployed on a larger scale, would have a major impact on data sharing for cancer research and treatment, or care based on precision medicine?

Exploring case studies of successful patient matching models at health information exchanges across the U.S. is another important area of research in response to the interoperability provisions of this Act. While the Act authorizes funding for the Cancer Moon Shot and Precision Medicine initiatives, additional appropriations will need to be made by Congress. So, our work has just begun to bring evidence to the table and ensure that an interoperable EHR infrastructure is enabling and not inhibiting the advancement of these important programs. 


Steven M Wagner's picture Steven M Wagner | December 27, 2016 2:04 pm MST

Great article Dr. Solomon. I agree with most and see the mounting pressure from the cancer moonshot project but there seems to be a contradiction by the government insisting on encryption (I think we all agree) and wanting ease of access, neither of which is easy and the risk of data breach and all its implications is astounding. It's not just "electronic" anymore. 

Michael R. Solomon's picture Michael R. Solomon | January 5, 2017 3:59 pm MST

Dr. Wagner,

You raise and excellent point that needs to be considered as the HIT community continues to march toward broad interoperability of electronic health records. The tension between securing health data and enabling efficient access will only rise as the number and variety of sources continues to grow. The access control, encryption, and data integrity criteria for EHR certification provide a sound foundation, especially since the encryption standards specified here are based on the NIST standards. If all developers complied the EHR certification standards, what’s missing? Colleagues in my circle of work are watching closely the application of blockchain technology to simplify and strengthen access control. It will be interesting to see how this innovative technology unfolds in the health care arena. 

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