Digital Health Space: What ONC's Cures Act Final Rule Means for Clinicians and Hospitals

It has been over ten years since GeorgeW. Bush established the Office of The National Coordinator for Health Information. The technology was established by He and his advisors were prescient about what was to come. It has been a long and stumbling road, but their action created movement and competition for the best solutions. As a founder of an "RHIO" (now an obsolete acronym), it transitioned into today's acronym, HIE, or Health Information Exchange. In the beginning, the movement was led by volunteers, unpaid visionaries who worked in the health system, and knew what was missing. Most of them worked, unrecognized with no financial reward. Its organizational structure was developed over a period of several years.

Early proponents developed a set of acronyms and tested several business models, most of which failed. The capital investment was and still is considerable. Federal and State grants were a temporary startup incentive. Most funding sources lasted for a finite time hoping other sources would materialize but HIE would fail financially. At the time the nation's largest HIE was the Indiana HIE which ran on a foundation of organizations and federal fundings. The Riverside Health Information Organization followed its own plan. The Riverside County Medical Association and San Bernadino County Medical Society joined forces and assisted area hospitals and providers to gain ownership of the project. In 2004 few providers or hospitals had electronic medical records. EMR was embryonic. There were few if any electronic health records to connect together. ONCHIT functioned to establish interoperability standards. This required another organization to certify the standard (CCHIT)

Medicare (CMS) realized this was their opportunity to derive clinical information from a wide variety of sources. At the same time, most clinicians wanted to have nothing to do with EHR for reasons now that are quite apparent. CMS quickly established a leadership role, and it played well to interoperability. CMS provided considerable financial incentives and/or penalties in order for hospitals and providers to purchase EHRs. Unfortunately, the systems were immature and user-unfriendly. Despite the severe limitations, the use of EHR increased until it reached a tipping point. Several large software vendors developed a large market share (Epic, Cerner, and others). The major market segments were divided into small to medium size provider groups and large enterprise systems such as Universities and large medical clinics.

As ONHIT was formulating a National Health Information Exchange, individual software vendors struggled to become certified, however, ONCHIT and Medicare continued to change the standard and developed a meaningful use standard that required certain data sets and reporting requirements to qualify for full Medicare reimbursements. The standard had nothing to do with hospital usage or provider usage.

The EHR systems remain poorly designed dysfunctional, inefficient, and have led to physician frustration reduced efficiency and early retirement for many physicians.

The latest update for Health Information Exchanges can be found at ONC's Cures Act Final Rule

What the Final Rule Means