AAFP Advises ONC, Continues Fight for Interoperability

February 23, 2018 03:21 pm News Staff – The AAFP is a recognized leader among national physician organizations when it comes to moving the needle on health IT. As such, the Academy didn't hesitate to provide input to improve a draft document put forth by the Office of the National Coordinator for Health IT (ONC) early in January.

In a Feb. 14 letter to National Coordinator Don Rucker, M.D., that was signed by AAFP Board Chair John Meigs, M.D., of Centreville, Ala., the AAFP noted that it "shares ONC's and Congress' goal of nationwide interoperability" and supports the goals outlined in the agency's 48-page Draft Trusted Exchange Framework.

Specifically, those goals aim to ensure that

physicians can access their patients' health information regardless of where their health care was delivered;
patients have easy electronic access to their health information;
physicians and payers who manage the benefits and health care of patient populations can get the information they need on a group of individuals without the onerous task of accessing patient records one at a time; and
the health IT community has open and accessible application programming interfaces to encourage entrepreneurial, user-focused innovation that will ease the accessibility of health information and enhance the usability of electronic health records (EHRs).

The AAFP said family physicians had experienced the "unintended consequences of overly proscriptive health IT regulations" and understand all too well that EHR products need to do more than just pass certification testing; rather, they must work for physicians in the real world of patient care.

That said, the Academy noted its support for the "voluntary nature" of the common agreement outlined in the exchange framework but expressed concern that the health IT market would fail to achieve -- in a voluntary manner -- the goals laid out by the ONC.

The AAFP urged ONC to track progress toward the goals and to be "prepared for further intervention should the goals not be achieved by the market."

Turning to another point, the Academy supported the ONC's intention to select a single entity to operationalize the trusted exchange framework. However, that "recognized coordinating entity" (RCE) must operate with appropriate oversight.

"We are concerned that a single RCE might function as a monopoly," said the AAFP. To prevent this, the Academy urged the ONC to "implement a process to track and investigate complaints within the RCE."

The letter also raised the issue of physicians' ability to easily access prescription drug monitoring programs (PDMPs) and noted that it is common for family physicians to care for patients in areas where state borders are easily crossed.

The AAFP called it an "avoidable administrative burden" when family physicians must interrupt their workflow to log into multiple state-based PDMPs. Each system has its own authentication processes, noted the AAFP, and it takes additional time for the physician to manage data from separate systems.

The Academy suggested that the framework include a process to incorporate PDMPs, pharmacies and the patient data those entities hold.

"Every day our members struggle with systems that are not interoperable," said the AAFP, and this failure potentially harms patients and adds another layer of administrative burden to physicians' work.

Stakeholders need to aggressively work toward achieving the goals outlined in the framework "and not settle for less," said the AAFP.

Physicians and patients deserve an interoperable health IT system that will ensure their health care system runs smoothly and safely, concluded the letter. "We look forward to opportunities to assist in making that a reality."

AAFP Expertise on EHRs Guides ONC
Key Message: FPs Need Interoperability, Not Administrative Burden
(6/8/2016)

AAFP Blasts ONC's Final EHR Interoperability Road Map
(10/12/2015)

Additional Resource
Trusted Exchange Framework and Common Agreement