Keep Your Crystal Ball – Un-predictions for 2019 – Volume 2

Written by: GLHC
Doug Dietzman

By Doug Dietzman, GLHC CEO

December 13, 2018

There is much uncertainty about what the future will bring for the health information technology industry. Doug Dietzman, Chief Executive Officer of Great Lakes Health Connect, an experienced professional and thought leader in the field, shares his thoughts on the current and future state of healthcare delivery and technology.

This is the first in a limited series of posts. Additional thoughts will be added through the end of January 2019. Find them on the GLHC blog, The Exchange!





The “Top 10” lists that are common this time of year always bemuse me. They all speculate on what will unfold in the year to come.

Those who create them are rarely held accountable for their predictions, but are still called “experts”. The lists all sound similar to each other and typically reflect the “shiny object” themes of the moment.

This is not one of those lists.

I have no interest in predicting what might happen in 2019 and glorifying technologies that are not ready for prime time. Instead, I want to offer practical thoughts and perspectives on what I think SHOULD happen in 2019 to advance health information technology and the healthcare industry generally.

This list will not be exhaustive, nor predictive.  It is meant to be practical and doable, while avoiding the “squirrels” that distract us from addressing the REAL challenges in healthcare.



See Volume 1: Interoperability HERE.

Volume 2: TEFCA

The Trusted Exchange Framework and Common Agreement (TEFCA) is the Department of Health and Humans Services (HHS), and Office of the National Coordinator’s (ONC) latest attempt to define standards for interoperability as required by the 21st Century Cures Act, which was signed into law in 2016.

As of this writing, I haven’t seen the revised draft of the TEFCA regulations to know what will be submitted in final form or submitted for additional comments. Clearly, there is a legislative obligation the ONC is working under. However, after the hundreds of millions spent over the last number of years to develop an HIE infrastructure covering most of the U.S., it makes no sense to mandate creation of another, duplicative interoperability layer with no funding, no sustainability model, and yet significant investment requirements.

National connectivity models already exist.

One example of national connectivity is the Strategic Health Information Exchange Collaborative’s (SHIEC) “Patient Centered Data Home”. This effort is connecting HIE networks across the nation in a robust query and push-enabled national network. These top connectivity models, developed over the last decade, are converging on their own to promote cross-network exchange. The cost of this connectivity is far less burdensome. Moreover, it will accomplish the federal goal of establishing query interoperability across EMRs nationally.

Building duplicative network infrastructure would only delay these more practical intra-network connectivity efforts. The entire HIT industry would need to shift priorities AGAIN to address yet another round of requirements that do not add much meaningful additional value at the local clinician level.

TEFCA also carries the risk of doing significant harm, or even putting some of the networks that have developed with federal investment over the past decade out of business.  The grass roots level will feel and carry the cost burden of this duplicative layer. The costs required to implement this new structure inevitably will be passed to end users.

Innovation and Progress

Great strides have been and continue to be made in furthering innovation around the business of exchanging information in healthcare.  HIEs have been at the forefront of this innovation and will continue to be a core enabler of a wide range of interoperability solutions locally and nationally.

In 2019, the ONC should set most of TEFCA aside. They should instead leverage and encourage the continued growth of existing networks and national agreements that are already in place. It took years and vast financial resources (both public and private) to build these organizations, develop their technical capabilities and infrastructure, and mature their business models to assure long-term sustainability. To hamstring their progress with yet another layer of interoperability mandates that do not address the core issues (see Volume 1), rather than encouraging their continued collaboration toward national connectivity, simply makes no sense.