By John Halamka As Meaningful Use winds down and incentive dollars are fully spent, what is the optimal role for ONC going forward?

Some pundits have suggested that ONC step aside and return all aspects of HIT policy and technology to the private sector. Others have suggested top down command and control of HIT including centralized governance to ensure interoperability.

Harmony is when all parties feel equally good about the path forward. Compromise is when everyone leaves the table equally unhappy. Here’s my view about the future of ONC that includes points from both sides.

The Argonaut initiative is a good exemplar of the private sector working to enhance interoperability in response to the market demands of accountable care organizations, which depend on data to succeed in a risk contracting world. There is clearly a role for the private sector to lead innovation and standards adoption, and this role will continue to grow as demand for richer interoperability increases and technology matures. However, even the best innovations require a regulatory and ecosystem context to enable the marketplace to blossom. The health care sector is the most fragmented industry in our complicated economy, both on the demand side (patients, insurers, employers) and on the supply side (physician practices and hospitals). ONC can be a focal point for the discussion of regulatory barriers to data liquidity, novel workflows, and alignment of incentives.

In Massachusetts, opioid abuse is a critical public health problem. We believe that collecting all opioid prescriptions at a state government level and sharing that data with licensed caregivers is appropriate. Yet, right across the border in New Hampshire, it’s illegal to share such data with government entities. Similar prohibitions exist on sharing immunization data to prevent measles outbreaks or syndromic survellience data to detect Ebola. Extrapolate this problem out to the various combinations of 56 states and territories and it’s an interoperability nightmare for patients, providers, and vendors. ONC can provide national frameworks that enable regional variation but can suggest guardrails so that a federated national network of interoperability and functionality is not impeded.

Canada has 35 million people. Sweden has 10 million. Healthcare IT policymaking that takes into account stakeholder opinions in these countries is easier than resolving the difference of 320 million US residents. Someone needs to be a convener to give voice to the myriad stakeholder priorities of a country that glorifies individual freedom. ONC can be such a convener.

The US government is a large player in the health care market, even aside from any oversight role it might play. Medicare and Medicaid are the largest health insurers in the country. The US government has over 20 million employees whose health benefits it covers. The DoD, VA, and Indian Health Services are large providers of care. The number of …read more