ONC Tech Forum 2020—An Attendee's Perspective

I attended the ONC summer Tech Forum in August 2020 which brought together over 1,500 industry experts and Federal partners to discuss technical innovations in health information technology and their potential impacts on the healthcare ecosystem.

Noam H. Arzt, Ph.D.On August 10-11, 2020 the Office of the National Coordinator for Health Information Technology (ONC) held its summer Tech Forum (see full agenda). This was a change in focus and format from their annual Interoperability Forum that has been held for the past several years. This year the forum was held virtually for the first time. The purpose of the forum was to convene industry experts and Federal partners to discuss technical innovations in health information technology and their potential impacts on the healthcare ecosystem. Senior ONC staff moderated the sessions, and I saw many of the "usual suspects" as well as some new faces presenting.

I attended several sessions. The plenary sessions that I attended had over 1,000 people on average in real time. As many as 600 attended the breakout sessions. On the second day ONC indicated that more than 1,500 unique individuals had participated in the first day's program. Interestingly, for those of us on the West Coast, no accommodation was made for the time zone - both days began at 9 am ET which I found particularly inconsiderate, and I was forced to watch the plenary sessions after the fact (they will remain posted for a few more months). ONC used an interesting and rich virtual conference platform I had never seen before provided by 6Connex, and I only saw a few times when presenters lost their connection mid-session.

On Day 1 there were two plenary sessions. The first was a "fireside chat" with ONC National Coordinator Dr. David Rucker moderated by Denise Hines from HIMSS. Dr. Rucker covered a number of topics, including the new regulations just going into effect for health information technology. He noted that had these rules been in effect several years ago we would have been in a better position to deal with the pandemic. He specifically mentioned information blocking, application programming interfaces (API) and the Trusted Exchange Framework and Common Agreement (TEFCA). Dr. Rucker also discussed an "app economy" for access to healthcare information as one measure of the success of what we are all working on.

Dr. Rucker and Ms. Hines spent some time discussing health information exchange (HIE) and its benefits to our healthcare ecosystem. One of the topics they mentioned was population health, with "shout outs" to a new Federal Notice of Funding Opportunity for HIE related to public health. This was the STAR HIE Program that was publicly announced following the Forum. According to the announcement, this new program "will build upon previous and existing federal investments in health information exchanges (HIEs) and will leverage work done by the industry to advance HIE services for the benefit of public health." The result of these efforts should be "improved linkages between public health agencies and the services that HIEs are well situated to provide."

The other major area of discussion was the Bulk FHIR standard which was covered in the second plenary session on the first day. Though that second session was not focused specifically on public health, there was some mention of the potential for Bulk FHIR to be used for public health reporting and/or surveillance. This is an interesting prospect.

The session ended with some future "visioning." Dr. Rucker saw the future healthcare system as one increasingly driven by consumer demand, a greater mix of virtual and in-person care, and more continuous versus the episode-driven flow of health data (enabled by more instrumentation that would lead to more process improvement and automation).

The plenary for the second day focused on global health, which was quite refreshing given how myopic folks usually are in the US and the global nature of the pandemic. Dr. Rucker moderated an informative session with a pre-recorded message from Australia (time zone differences did not enable the speaker to participate) and contributions in real time from Canada, Hong Kong, the Netherlands, and the UK. It was interesting to hear about the progress, and idiosyncrasies, of each country and its approach. There was some discussion of the Global Digital Health Partnership (GDHP) which conducts projects and planning across its member countries and which has a work stream dedicated to interoperability. The GDHP recently released a white paper on this topic.

One of the most interesting parts of the conversation was focused on the efforts made by Honk Kong to develop an open source digital health platform. Over the past 20+ years, Hong Kong has been pursuing a "one system, one record" policy primarily built on open source components. Though they had little money to invest at the beginning, for them open source is more about retaining control than about controlling cost (though the lower price tag certainly got them started down this path). With respect to standards, they have an "adopt, adapt, invent" philosophy in that order. As a company, HLN ascribes to similar approaches when we work with clients; we want them to retain as much control as possible, leverage what exists before inventing something new and consider the total cost of ownership of a particular investment.

During the rest of the conference there were breakout sessions across four tracks:

1. Content Exchange Standards
2. Technical Framework for Trusted Exchange
3. API Standards and Innovation
4. Tech in the Continuum of Care

On the first day, I attended several sessions, including one on barriers to laboratory interoperability, primarily addressing laboratory to electronic health record (EHR) communication. This session focused on several of the current limitations ranging from inconsistent coding of laboratory results to file formats (like HL7 v2 and Clinical Document Architecture, or CDA), data transport strategies (like Direct), and other issues that have surfaced during COVID-19 test reporting. I attended another session on laboratory reporting to public health specifically which shares many of the same barriers as well as issues due to incomplete patient demographic information on many lab result records.

On the second day, I attended a session on issues that will emerge over time in discovering FHIR endpoints as more and more sites come online. The primary use of FHIR is a system to system query between EHRs and potentially other systems as well. But before one system can query another it has to identify the endpoint to which to send the query request. With potentially hundreds of thousands or even millions of endpoints we need an authoritative way to discover what these endpoints are. The most interesting part was a piece on the Lantern project which is going to be used to monitor the availability and adoption of FHIR API service base URLs by select users across the US.

Continuing a focus on FHIR, I then attended a session on issues related to migration from CDA to FHIR which covered current work in an HIE environment (New York eHealth Collaborative, or NYeC); the FHIR At Scale Task Force (FAST); some work being done by the Commonwell Health Alliance related to trust; and the latest efforts for FHIR compatibility for electronic case reporting (eCR). Finally, I attended another session on APIs to support population health queries which included discussion of FHIR Bulk Data Access and the use of FHIR for population health with CDC and a state-level HIE (CRISP).

Overall, the content covered in this Forum was relevant and timely. Still, though, the virtual format was no replacement for an in-person conference no matter how much ONC wished it was. In particular, networking opportunities just did not translate to this virtual format, and I am still looking for a way to download slides (as opposed to listening to recordings of the sessions which I know how to do, at least for now). While COVID-19 was certainly on everyone's mind, concerns about (or even issues related to) the pandemic did not overwhelm the meeting.