By David Bucciferro (Foothold Technology-Radicle Health), Outgoing Chair, EHR Association

Reflecting on 2023, the year was dominated primarily by five issues of importance to the EHR Association and its 29 member companies, all of which aligned with our overarching focus on collaborative efforts to accelerate health information and technology adoption, advance interoperability, and improve the quality and efficiency of care through the use of EHRs.

1. HTI-1 Final Rule

ONC’s HTI-1 final rule, which was issued in December just five months after comments closed on the proposed rule, is easily the biggest news of 2023. While we are reviewing the complete final rule to fully understand its impact on our member organizations and their healthcare clients, we came away from our initial analysis with a mix of reactions. First, it was clear that ONC heard the broad industry feedback that many of the proposed deadlines were infeasible compared to the scope of work required for compliance. However, we were disappointed to see that many remain unchanged from the proposed rule. Particularly concerning was the fact that the short timeframe allotted to deliver the required DSI transparency functionality remains problematic, even with the reduced scope of work. 

2. Balancing State and Federal Mandates

The sweeping mandates under HTI-1 add to the complex and multifaceted nature of health IT compliance and regulatory requirements with which EHR developers must contend. It is a landscape encompassing not only national standards set by ONC, CMS, FDA, and other regulatory agencies, but also state-specific requirements – primarily around privacy, security, and patient information sharing – which are often in conflict with federal mandates. Addressing the heightened complexity and lack of standardization this state-federal balancing act creates for EHR developers and ensuring our members’ voices are heard at the state level represents an important pivot for the Association toward a greater emphasis on monitoring and sharing feedback around state health IT-related policies than in past years, one we will carry forward into 2024 and beyond.

3. Artificial Intelligence (AI)

Another focal point for the EHR Association in 2023 was the work underway by ONC and the FDA to guide and regulate the use of artificial intelligence (AI) by healthcare organizations, with a particular emphasis on clarifying the distinction between clinical decision support (CDS) and EHRs. In HTI-1, ONC broadly defines AI technology as “predictive decision support interventions” and establishes transparency requirements that impact its development and use. These ongoing regulatory efforts and the significant potential AI holds for improving clinical outcomes and relieving administrative burdens are why the Association is establishing a task force dedicated to studying issues related to its advancement deeper into healthcare workflows.

4. Information Blocking

We also continued our work around information blocking and supporting efforts to share EHI to improve patient care. This includes providing health IT developers with as much information as possible to help them and, subsequently, their customers, comply with current and future regulations and protect against potentially crippling penalties. This includes the publication of Good Information Sharing Practices, a practical list of proactive actions health IT developers can take to demonstrate their strong support for access, use, and exchange of health information, and compliance with information blocking regulations.

5. Disability Inclusion

The EHR Association focuses on issues beyond policy, however. In 2023, our User Experience Workgroup launched its Accessibility Personas Project, which is focused on advancing disability inclusion. The work underway seeks to build awareness of how disability exclusion impacts health IT users and identify design solutions to eliminate the challenges. This includes examining the role of personas in supporting accessibility in EHRs and is expected to result in expanding the Association’s Personas Library to include Accessibility Personas, as well as potentially creating workflow scenarios and other resources designed to highlight those scenarios and offer solutions. 

These are just a few of the highlights from our work in 2023. For more insights into our accomplishments, we encourage you to visit the Resources section of our website, where you’ll find all our comment letters, RFI responses, and statements, as well as links to various white papers and tools we’ve published to support our membership. 

On behalf of the EHR Association, we wish you a Happy and Healthy New Year!