20 Years of Interoperabiliy and the Office of the National Coordinator of Health Informatin Technology (ONC)

The health information exchanges and interoperability has advanced since its inception in 2007.  The recent ONC luncheon meeting which was on Zoom May 9,2024 The attendees. were all the coordinators, beginning with David Brailer MD.

ONC was literally a new governmental administrative department.. Dr. Brallier was prescient and organized how it would grow.  Their was open communication between successive coordinators to develop a cohesive and smooth growth pattern.

There were a number of government agencies involved in HIE, including CMS, CDC and HIT vendors.  The structuring of medical history and billing codes, along with diagnosis led to many features of using electronic health records.

Integrating EHR into daily physician and providers was and still creates challenges. On a day to day basis it created difficulties in work flow and efficiencies 

It was also very expensive, impacting practice budgets and reducing funding for other important expenses, such as capital investment.  It requires the addition of IT personnel and IT training of physicians and all other personell such as nurses and other medical assistants.

HIE was supposed to reduce paperwork, and improve billing. HIE and EHR created patient portals for communication of office visits, laboratory results, prescription renewals.  

It has a role in current physician burnout, early retirement and loss of physicians.

One of the main reasons given for physician burnout is the electronic health record. It reduced face-time with a patient, and increased time between patient encounters

It produced a need for government intervention to supplement the cost of capital investment.  CMS used criteria such as Meaningful Use and inclusion of items which had nothing to do with day to day entering data into the EHR. Some physicians utilized a transcription  aide, usually a medical assistant, or took the work home after hours to complete the process.  EHRs are not forgiving since each data field must be filled. This increase the amount of information required.  While it ensured a complete record it took much more time.  Physicians used copy and past often to work around this requirement.

The addition of LLM and A.I. will allow real time voice transcription directly into and EHR.

ONC required software and EHR vendors to upgrade their software to meet CMS requirements almost yearly.