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And today we take a look at that with one of the people who pulled it together. Seth pki, the director, . Of the strategic planning a and coordination division of the ONC for Health Information technology. Seth, welcome to the show. Thanks, Seth. Uh, welcome and thanks for, uh, having me on the show. Yeah, I'm looking forward to it.

And we've seen a lot of continuity and bipartisan support in the past, and. In both of the, of the significant legislations for ONC and that have shaped prior strategic plans on this one with the High Tech Act and the 21st Century Cures Act, we, we, the plan is incorporates those legislations and sets that as a key piece of the federal health IT strategy.

Yeah. And, and we're gonna talk a, and 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 gonna change. So let's just dive into the strategic plan. Uh, but first, tell us about the process.

How do you come up with a plan? What's, what's the process you go through for it, for developing the plan? Sure. The, the HITECH Act is what, uh, 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, um, was led by ONC, but was developed in collaboration with around 25 different federal organizations. We convene those federal partners. In a, a series of working sessions to develop the initial draft. That 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.

We also received nearly 100 public comment submissions as a part of the public comment. Process. 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. Is there, is there an underlying set of assumptions around the problems that we're facing that inform the plan from from year to year?

Yes, 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 healthcare system, so a broader context in just health IT specifically, but what are those things happening in the healthcare industry that can affect health it?

And then we also look at what are the opportunities in a digital health system. That it are enabled or empowered because information is electronic and can be access exchanged and used more easily. 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.

So both care and technology as well as the ability to access, exchange and use that electronic health information. And within that broader healthcare context, you take a look at, okay, what are the opportunities in a digital health system? So empowering patients, that's the foundation. And one of the primary, uh, drivers, uh, with the federal health IT strategy is providing access.

To patients and individuals to their own health information. We also look at the continuing to move forward in 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.

Those are some of the foundational pieces that we look at as our unique opportunities in a digital system. Yeah, so. You have six principles that, uh, underlie the strategy. I'm just gonna run through 'em real quick and then I wanna touch on them. So you put the individual 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. It's really been a hallmark for quite some time, but it's really been a hallmark of the verbiage that Sema Verma has been talking about, uh, and Secretary Azar, but really, SEMA Verma has been out there talking about the patient at the Center of transparency and all those things.

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 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.

Yeah. You also have built a culture of secure access to health information. Is that just taking it to the next level in terms of talking about the, the need for privacy and security around, around the patient accessing their information and the sharing of information? I. It certainly includes privacy and security, I would say more broadly reflects the focus of, uh, one of the objectives within the federal health.

IT strategic plan is to set expectations for data sharing. Those include privacy and security and information. And you can see that embodied in some of the, the policies that are coming out within the 21st Century Cures Act, final rule from ONC, for example, setting requirements around. Privacy and security, and we anticipate that as well through programs like the trust exchange framework and common agreement that will continue to establish those data sharing expectations for the various stakeholders who, who are sharing information across networks.

All right, so you introduce the four goals in the strategic plan framework. Promote health and wellness, enhance 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, in this plan? So it is, uh, intentionally a broad strategic plan that reflects the various roles that federal agencies play within the healthcare and health IT industries. And at first and primary, when we, um, began working with our federal partners, we want it to develop and outcomes.

Driven plan. So we were focused on who benefits as a result of the implementation of the strategy. You'll see that we highlight a variety of stakeholders, including patients and populations, caregivers, healthcare providers, payers, public health professionals, researchers, and others. Who really are the, uh, key groups that we hope will, 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, um, providers and payers are engaged in the system. The third goal is really around. Researchers and innovators, developers around building that secure data-driven ecosystem to accelerate research and innovation. And then the fourth goal really cross cuts.

The first three, it's around those that policy and technical infrastructure, um, that can support the other three goals and the organizations that we hope will benefit, uh, from those goals. Um, some agencies taking. To build off of this federal health IT strategy with the federal electronic Health Record Modernization program office, adopting the same goals in their interoperability modernization strategy, supporting the Department of Defense and Department of of Veterans Affairs, and specifically around that first goal around promoting health and wellness.

It's. Making sure that individuals have access to usable health information. Again, continue to focus on that patient access piece. The second 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 supported outside of

we're. Promoting health and wellness and using technology, health information to support individuals and populations. We'll get back to our show in just a minute. I want to give you an update on the CliffNotes Referral Program. For those of you who don't know what CliffNotes 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.

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With that in mind, let's get back to the show. Yeah. I often say that this show is the education of Bill Russell, and so you're gonna 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 fccs goal to increase access in rural and in remote communities?

To health as well as access to health information? Is that how that works? 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, dis disabled and tribal populations. And so there are various federal agencies that focus on specific populations that they serve.

And across those agencies, 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 usable health information. It's interesting. It, it's interesting how this gets used. So if, if I'm with a, a, a, another part of the federal government and I'm thinking about health. Health disparities or social determinants, or, I'm thinking anything regarding health and technology, I would refer to this plan and I might even adopt some of these plans, uh, some of these aspects as we're developing our goals and guidelines for moving forward.

Is that how that works? Yes, 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 their budget requests 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 around aligning and coordinating efforts, and I mentioned that they're the, that we are seeing other agencies, for example, align their strategies to this federal health IT strategic plan.

Also a coordinate across federal. Agencies that are engaged in health it, which is numerous, and we can coordinate on things like standards. The federal government is actively, you know, working across our partners and ONC is facilitating that coordination around things like the fire standard and how that can be expanded and used for a variety of federal health use.

Cases across agencies, so two together and align around common standard. 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, um, can be used as a communication to inform the private sector. What are the priorities of the federal agencies?

And then the last part is it can also be used as. To benchmark and assess progress, and so we are focused on within OC and working with our federal partners around five.

We'll help advance overall the goals of the strategic plan. That's, you know, one, as I mentioned around promoting the use of fi, the fire standard across federal organizations. Also, we're looking at using secure standards-based application programming interfaces to provide electronic . Health information.

A third piece, again, another standards piece is around building off the US core data for interoperability standard, uh, that was established in NCS 21st century, uh, curious Act, final rule, and using. Building off that for additional data classes and elements that support federal use cases. And then the last two pieces are around those data sharing expectations.

So the turning information, blocking practices using federal authorities and investments, and then encouraging data exchange across networks. 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, uh, from an OC standpoint, focusing a lot of our coordination efforts with our federal partners.

It's interesting, the, you know, a lot of health systems are focused on the experience and the delivery of care, and you have a whole, uh, section of this as you, as you talk. The second, the second goal of this is enhance the delivery and experience of 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, how people are able to utilize technology and the burden sometimes that comes along with the technology.

So talk a little about what you're trying to achieve in the experience of the

plan. C did a specific strategy in response to a congressional requirement that was focused on provider burden reduction. So this plan, you know, takes into account those specific activities that are, and recommendations that are were described in, in that joint fat strategy from HHS on reducing, um. It acknowledges that clinicians face a significant amount of time entering data and other documentation and EHRs for reimbursement purposes, quality public health, uh, 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 streamline processes to reduce the level of effort for healthcare providers, um, and health systems in responding to those, uh, federal requirements. So OC is, um, actively engaged in on those pieces.

And for example, we're, um, currently working with our Health IT advisory committee. In a task force that's focused on the intersection of clinical administrative data, looking for efficiencies and how, uh, we can merge those data for purposes of improving the prior authorization experience. So we're actually looking forward, um, to getting recommendations from our federal advisory committee later this year on what would be some recommendations and.

Clinician burden. 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 kind of things? Is that what that potentially leads to? Uh, that would be, that's the intent of the, the objective within the plan is to reduce that regulatory administrative burden to taking those administrative require requirements and allowing clinicians to have more time with their patients and have a better overall experience.

Deliver healthcare. And again, o put out an entire strategy focus on recommendations there for, um, both ourselves and some of our federal partners. And we're are working to take steps, um, against that strategy. So you talk about the data-driven ecosystem. And, uh, it, it, on this show we focus an awful lot on provider to provider sharing.

And we talk, uh, 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, to the healthcare system. Our, 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, uh, sometimes just gets lumped under social determinants, but, but 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 the health of a population. 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 multiple sources to unlock the power of that information.

And so with access to data and technology, it creates the opportunity for advancements in 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, uh, innovation, but also then reducing the time and it takes to translate that learning into decisions that at the bedside.

So furthering provider access to data stored in EHRs and. And in particular, leveraging secure standards-based application programming interfaces to empower individuals, providers, payers, public health researchers, all those stakeholders in, in the ability to both collect that information and then use it to gain knowledge and learning.

In healthcare, there's an awful lot of innovation coming down the pike. We have ai, machine learning, we have, uh, fires opening up access to data stores. We have new entrants and new players. We have big tech coming into healthcare. This the thing about this, is it really it again, patient first or per I'm, I'm gonna get the wording wrong, the individual first.

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, or am I missing the Mark A. Little bit there? No, that's a key. You know, part of our focus and our messaging really is about promoting modern health IT for all stakeholders. 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 use of health information. And going back to some of the points, um, that we emphasize for ONC collaboration and coordination purposes with our federal partners, it is some of those technical pieces that broadly support stakeholders like providing access through those secure standards, space application programming interfaces.

As far as.

Patient information, but also information at a population level. It focuses on common standards so that we're building off of the. Standard and supporting various use cases and various populations that federal agencies serve. Same thing with the US core data 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.

And then the last piece really is 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 exchange across networks, both at the national and community levels.

Well, Seth, this is, uh, this is great work and I really appreciate you coming on the show to, uh, share it with us. Uh, how can people get access to this? I downloaded it off the off the off the website is. Is that the best place for people to go? Where would they go to get the report? I. Yes, health it.gov is where the 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, um, that we've uh, 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 in the industry That's also available on health it.gov.

We intend to align that report to be our primary way that we're communicating progress against the federal health IT 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. Yeah, it is, it is really a well laid out site.

It's pretty easy to find. October 30th, uh, news, federal Health, IT strategic plan.

You can also get it off the, uh, blog as well. And actually it's just a really well easy to, uh, navigate a website for those who are wondering if a government website's easy to navigate. This one is fairly, fairly easy. Has a ton of great information. Again, Seth. Thanks. Thanks for coming on. I appreciate it.

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