For years violently bipartisan, it looks like the Trump administration may want to turn healthcare interoperability in the US on its head, for reasons so far unknown.
A memo sent to the Health Information Technology Advisory Committee (HITAC) by the Trump administration (via the Office of the National Co-ordinator of Health IT) has “indefinitely cancelled” all meetings of the Committee, throwing into confusion the status of interoperability health technology policy in the US.
The HITAC is a key body established by the 21st Century Cures Act to oversee and recommend national healthcare interoperability policies and standards to the ONC in the US.
For over two decades the ONC has passed between Republican and Democratic administrations relatively seamlessly, based on what has been until now, one of the few bipartisan projects the two parties always seemed to have agreed wholeheartedly on.
In Australia over the past few years, increasingly, the Department of Health and Aged Care (DOHAC) and the Australian Digital Health Agency, have been studying the US journey to significantly enhanced technical interoperability of healthcare data sharing in the US, via the 21st Century Cures Act and the establishment of DITAC as a body that oversees the ongoing development of the principles behind the Act.
The first step in going down a similar path to the US, albeit adapted for the significant differences in our healthcare systems, is set to go before parliament in the next two weeks in the form of the Modernising the My Health Record Sharing by Default bill, an update which will introduce the idea that healthcare providers across Australia are going to need to work out ways to share meaningful patient data seamlessly and in near real time across the healthcare system, where it makes sense.
Importantly this bill introduces the concept for providers and software vendors that sharing of data will be mandatory in the not-too-distant future and that mandate will include rules to make sure your software is able to share, as well as rules saying you must share.
This Modernising the MHR bill isn’t quite the 21st Century Cures Act, which essentially gave software vendors and providers just five years to build out aligned technology for sharing and standards to do that, but it is understood, it is laying the groundwork for that step to be taken by the government in the not-too-distant future.
That step is going to cause quite a bit of soul searching among the software vendor community, many of whom would have a lot of work to do to upgrade their systems to share data securely and seamlessly via the cloud, and some of whom have established what some increasingly feel are gated information platforms, where the only sharing that is allowed is by agreement with (and usually payment to) the platform vendor.
It’s the same model as the giant global digital platforms like the Apple iPhone and Amazon, where distribution and access to audience is gated.
The problem for some vendors in a 21st Century Cures scenario, and possibly the government, is going to be, can you gate access to healthcare providers if you own the platform they work on?
The US cancellation memo puts an immediate hard stop on a lot of complex work being done in the US to align all the 21st Century Cures interoperability standards and technology alignment work with the rapid adoption of AI throughout the healthcare system, so there is a lot of confusion among healthcare leaders over there.
Until this event AI was being viewed across the US healthcare landscape as a major way to introduce significant new efficiencies into the system via scribes and, increasingly, significantly streamlining administrative processes.
In the past few years, the previous administration had pushed further on making vendors and providers make it easier for patients to access their data and for vendors to disclose key information on how their products work, in particular, what parts of their software rely on AI.
The HTI-1 rule requires software vendors to disclose how their AI products were trained and tested.
As per a lot of Trump administration process so far (a from the top and on the run policy making process) no one in government is returning calls on what happens next.
Health Services Daily has asked the ONC what is going on directly, but it’s unlikely we will get a response – at least on record. So far the ONC has made no comment to anyone in the US.
Industry commentators in the US are saying that the DITAC hard stop is likely the same tactic that has been used across most government organisations by the new administration which is to tell everyone to stop everything until someone in the new administration reviews current work in the light of the new administration priorities.
Someone clearly didn’t send the new administration the memo saying that healthcare interoperability is on that very short list of things both parties have always violently agreed on.
Already some senior US healthcare leaders are saying the memo is, like some others sent the past few weeks by the new administration, in violation of law.
In a report in STAT this week, HITAC member Deven McGraw said the suspension was in violation of the 21st Century Cures Act.
“HHS didn’t create HITAC of its own volition—Congress mandated creation of HITAC, and set forth a primary and secondary list of target areas for HITAC to follow in coming up with policies and technical standards to promote and facilitate the interoperability of health information to improve individual and population health,” Mr McGraw, told STAT.
Does any of this have implications for Australia’s significant current program of “sharing by default”?
The only possible lesson is that no matter how much government departments or agencies think both the opposition and current government are in synch on what seem to be obvious and sound policies for our health system, all bets can be off regardless once you have a new government.
If you want to read more on the topic you can HERE and HERE.