ONC’s Rucker says it’s time for a regulatory overhaul of health IT

The national coordinator for health IT said Tuesday that regulatory accumulation in the health care sector is impacting how it embraces technology moving forward, and it’s time for reform.

ONC chief Don Rucker said at a Bipartisan Policy Center event that his office’s mission in promoting the adoption of interoperable electronic health records also calls for a restructuring of the regulations governing the amount of documentation physicians must provide.

The burden of those regulations began with the price-setting requirements first laid out in Medicare, setting off what Rucker called “microscopic distortions of the health care economy” that trickle-down to the speed of health IT adoption today.

“After 50-odd years in health care, we have misallocated every single resource in health care,” he said. “And you only have to look at some of the mega-hospitals and the provision of services — the overprovision of services, the underprovision of services — to know we have a broad-ranging distortion.

“[Health IT] is really part of that broader ecosystem, so as we look at policies, we have to look at the totality of it. In that context, for the American public, this is, ‘What are we getting for our money in health care,’ not, ‘What are we getting for our money in health care IT?’”

Rucker’s remarks coincided with a report by BPC calling for a scale back of the ONC certifications originally designed to promote EHR adoption as part of the 2009 Health Information Technology Economic and Clinical Health, or HITECH, Act.

The report, co-authored with stakeholder group Health IT Now, outlines the principles of an oversight framework to further health IT advancement. But it also says with the growth of EHR use in the past decade, the regulations promoting incentives for its adoption are now outdated.

“We want a careful review, identification, elimination and reduction of burdensome regulations,” said Joel White, Health IT Now executive director. “About half of the certification requirements aren’t actually used by doctors in needing or receiving payment in the Medicare program. There seems to be a disconnect.”

Many of those regulations were crafted to ensure the technology health professionals adopted met the standards for “qualification for federal incentives under the [Centers for Medicare and Medicaid Services’] EHR Incentive Programs,” the report said, but it also notes physician incorporation of EHRs has grown from 48 percent in 2009 to 87 percent in 2015, negating the need for those certifications.

ONC later expanded certifications in 2016 to promote interoperability, but the report argues that with the enactment of the 21st Century Cures Act in 2016, the Department of Health and Human Services and the Food and Drug Administration — which regulates medical devices — are crafting policy that calls for developer-based evaluations and includes third-party certification of developer quality.

To reshape the role government plays in health IT, the report outlines recommendations that encourage core consumer protections and promotes private sector consensus standards

“Health IT Now believes that the certification program ought to undergo a significant reworking and that most of those activities should be reverted back to the private sector,” White said.

Rucker said a lot of the regulations and payment requirements that physicians are struggling with now had a role to play when they were first developed, but technology has moved on and HHS is working on updating the regulation to match.