Will New ONC Rules Open Up the Walled Garden?


Editor’s note: Cambia Grove is proud to partner with the innovation community to amplify their perspectives on topics applicable to the larger health care ecosystem. This blog post from Ed Butler, our Advisory Panel member and the Managing Director of Agate Point, recaps an Under the Boughs event with Dr. Don Rucker, National Coordinator of Health Information Technology at the ONC. This event is part of a broader health care trend surrounding interoperability of data.

The views expressed in this article [or on this website] are solely those of the author and do not necessarily reflect the opinions or positions of Cambia, Cambia Grove, or any other entity or organization.

“This is the biggest pro-market move in health care since Medicare,” we learned from Dr. Don Rucker, the top federal health IT leader within the U.S. Department of Health and Human Services, when he visited us at the Cambia Grove on April 17. This was another event in the insightful Under the Boughs series with Dr. Lee Huntsman. Lee displayed his usual equanimity and provocative questions, and as a result, we were treated to an insider’s view of the politics and the economic drivers of the $3 trillion US health care industry.

Dr. Don Rucker, who leads ONC, is the seventh National Coordinator for Health Information Technology, and the sixth of this lineage that I have had the opportunity to hear speak. This event came at a critical time, just 48 hours before the extension of the comment period on proposed rules to implement data access provisions of the 21st Century Cures Act. This conversation was quite a memorable experience for three reasons. 

First was the refreshing civility of the discussion, given the potential for controversy. Second was the surprising personal charisma of Dr. Rucker. His 30-year background as a physician-technologist with extensive experience with health IT companies and health care providers came through. He knows what’s going on and has a down-to-earth candor that invites careful listening. Third was the free-market ideology that thoroughly permeates his rationale for supporting these new federal mandates. The root cause of the American health care system problems, in his view, is that we lack market pricing. 

Dr. Rucker outlined 3 “big asks” from the 21st Century Cures Act that ONC was tasked to implement. Two related rules came out—one from ONC specifying the rules and the other from CMS enforcing via Medicare payment mechanisms.

  1. No information blocking. Congress intended that patients can control their data and get their data. This cannot be blocked by health care providers or vendors. Certified Electronic Health Records (EHRs) must make this possible, and providers cannot interfere. ONC defines “allowable exceptions” in the proposed rule. 
  2. Trusted Exchange Framework Common Agreement (TEFCA) has explicit technical provisions. (The newest version was published April 19, with comments due June 3.)
  3. The most transformational ask was for Open Application Program Interfaces (APIs). Congress mandated that APIs cannot require “special effort.” The ONC has taken this to mean that health IT interchange standards should use the same frameworks as other parts of the modern communications world—RESTful APIs, JSON, and on top of that, an HL7 specification called FHIR that defines vocabulary and formatting. OAUTH2 is an open standard for secure delegated access to server resources. The premise is that by providing patient’s with access to their data, along with price transparency, this reform will unleash the power of consumers as a counterweight to siloed interests.


Dr. Huntsman asked, “Is this a grenade blowing the doors off the walled garden?” Dr. Rucker paused, then said, “Yes…robust APIs have democratized music, publishing, taxis, airlines, weather. Why not health care?”

Why not in healthcare? Divergent interests of stakeholder sectors slow progress. Walled gardens exist for a reason. Those of us who see the transformational potential of opening up healthcare information can review and comment on these latest proposed regulations. No doubt those who benefit from maintaining the status quo have already responded. There is a reason the deadline was pushed back. Federal health IT policies have consequences beyond the beltway. It’s time to pay attention.

The comment period on the proposed rule was extended to June 3, 2019. For more information see these links:

Opportunity for developers to be trained in HL7 FHIR data standardshttps://www.cambiagrove.com/programs-and-initiatives/cambia-grove-innovator-fellowship


Ed Butler is the founder and managing director of Agate Point, a health care solutions integration firm. He is a board member of Health Innovation NW, a non-profit supporting grassroots innovation in the health care industry and serves on the Advisory Panel of Cambia Grove.

Cambia Grove explored this topic in depth on June 20th and 21st at the Interoperability Summit: Empowering Consumers with Data.