Behavior remains a significant challenge in ensuring seamless health data exchange, according to a blog post authored by Micky Tripathi, assistant secretary for technology policy, national coordinator for health information technology and acting chief artificial intelligence officer at HHS. The 21st Century Cures Act (Cures Act) of 2016 required certified EHRs to support the access, exchange and use of data without special effort through APIs. Since January 1, 2023, all certified EHR users are required to have standardized FHIR APIs for patient and population services to exchange data with patients and authorized business partners. According to Tripathi, the majority of certified developers have published their certified APIs and associated documentation on the publicly accessible Certified Health IT Product List.

Health information technology standards are used in the health care industry to facilitate the capture and exchange of information.1 Health information exchange organizations (HIOs) are state and regional networks that enable electronic exchange of health information across their participants, which may include health care providers, public health agencies, payers, and other health care entities. 

More than one-third of health information exchange organizations (HIEs/HIOs) reported that laboratories have limited or refused to provide access, exchange, or use of electronic health information (EHI), according to a 2023 national survey. A recent data brief from the HHS Assistant Secretary for Technology Policy (ASTP) highlighted findings from the survey, but stopped short of characterizing the impediments as “information blocking” under the 21st Century Cures Act without further investigation. Among HIOs that experienced impediments in access to data by laboratories, about 1 in 5 indicated that they were not at all able to overcome these difficulties to access lab data, the data brief said. Nearly 4 in 5 HIOs that experienced an issue with access to data reported that they were able to overcome difficulties due to lab impediments “to a small extent” (22%) or “somewhat” (57%). Notably, no HIOs reported that they had been able to “fully” overcome these difficulties to access data from laboratories and only 4% reported being able to overcome these difficulties “to a great extent.”

“We hear more and more about people being concerned about getting too innovative in the healthcare space, and a desire for guardrails to help channel that innovation appropriately,” Tripathi said Tuesday. HHS components — like the National Institutes of Health, the Advanced Research Projects Agency for Health, the Centers for Disease Control, the Centers for Medicare and Medicaid and the Food and Drug Administration — have found a wide array of AI use cases. As with other agencies, creating internal chatbots to help HHS employees sift through large volumes of diverse data is a popular use case for HHS, but Tripathi notes that major commercial players, such as Meta’s Llama and OpenAI’s ChatGPT, are not trained on clinical data.

Tripathi said HHS is looking to leverage the vast troves of clinical data across HHS and other agencies to create finely-tuned AI models tailored to healthcare uses. 

Our country has made tremendous strides and invested billions of private and public dollars in establishing the digital future of the health care system. We are thus highly concerned about ongoing and recent reports that we have received about potential violations of both the letter and spirit of the various laws and regulations now in place to ensure information-sharing to improve our health care system and enhance the lives of all Americans. In this blog post we describe some of the issues that have been brought to our attention and the steps that we are taking to address them.