Interoperability starts now

December 12, 2014 in Medical Technology

With electronic health records now in place in hospitals in hospitals and medical practices, the Office of the National Coordinator for Health IT embraced its new mandate in 2014: getting them to talk to each other.

Toward that end, it shuffled its organizational structure, began work laying out a 10-year roadmap for true, nationwide interoperability and started soliciting advice and feedback from reports put out by other federal entities, notably JASON.

In September, ONC’s HIT Policy Committee established a JASON Report Task Force, co-chaired by Cerner Senior Vice President of Medical Informatics David McCallie and Massachusetts eHealth Collaborative CEO Micky Tripathi.

The task force is charged with digesting the report, “A Robust Health Data Infrastructure,” prepared for AHRQ by the MITRE Corporation’s JASON advisory group, and making suggestions to ONC about what to do with its findings.

The JASON report contends that “the current lack of interoperability among the data resources for EHRs is a major impediment to the effective exchange of health information.”

But Tripathi and McCallie argued that JASON “seriously underestimates the progress made in interoperability” – even while they agreed that “there is considerable room for improvement.”

Since the report was launched in early 2013, a lot of strides were made, they argued, “such as market deployment of Direct-enabled functions, and beginning of MU2 attestations using C-CDA”

To that point, they argued, “ONC should take into account the current state of interoperability as well as current trends before incorporating JASON findings in any decisions on HIE plans, policies and programs.”

Among the task force’s other recommendations: ONC should “take immediate actions to motivate a public-private vision and roadmap” for a nationwide architecture for data exchange – an effort that, ideally, would nudge market forces toward developing “data sharing networks that would deploy public API that would expose core data services and core data profiles.”

The government should be a “market motivator,” Tripathi and McCallie argued in a final report delivered on Oct. 15, with ONC “assertively (monitoring) the progress of exchange and implement non-regulatory steps to catalyze the adoption of Public APIs.”

Also, Stage 3 meaningful use should be less stringent, in order to health IT vendors the necessary latitude to develop innovative products, the task force argued.

“In order to allow vendors and providers to focus their efforts on interoperability, CMS and ONC should narrow the scope of MU Stage 3 and associated certification to focus on interoperability in return for higher requirements for interoperability,” they wrote.

In June, ONC cast longer view, releasing “Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure,” which laid out steps toward a future where “the right data (is) available to the right people at the right time across products and organizations in a way that can be relied upon and meaningfully used by recipients.”

Using this “roadmap,” ONC hoped that, by 2024, “individuals, care providers, communities, and researchers should have an array of interoperable  health IT products and services that allow the health care system to continuously learn and advance the goal of improved healthcare.”

To get there, DeSalvo said ONC would would focus on core technical standards and functions; certification to support adoption and optimization of health IT products and services; privacy and security protections for health information; supportive business, clinical, cultural, and regulatory environments and rules of engagement and governance.

But some were impatient with that strategy. As John Loonsk, MD, former director of interoperability and standards at ONC, wrote in a Healthcare IT News opinion column, “It is a simple question: ‘Why doesn’t electronic health information flow after the nation spent $26 billion on electronic health records?’ Suggesting a 10-year timeframe or arguing that there is progress if you look hard enough just doesn’t answer it.”

A big part of the problem “is that there is no real technical plan,” he argued. “From a health IT perspective, the kind of ‘plan’ that is needed would describe high-level functional needs, identify important technical elements, and show how they all fit together. It would be an architectural blueprint to guide technology in the very complex, loosely coupled system that is the health sector. And it would strategically articulate critical, but limited, pieces of the national health IT infrastructure. It would also show how what exists needs to be supplemented and changed to achieve the future state. It would be, in short, more of a high-level technical architecture than a roadmap.”

Roadmaps have their value, of course, wrote Loonsk, but “the nation needs to know where it wants to go in order to use a map for how to get there. Some, who not infrequently would rather go their own way, attack the word ‘architecture’ as meaning ‘top down control.’ So call it a ‘technical plan” or a ‘framework,’ call it a ‘design pattern,’ a ‘schematic’ or whatever you want; interoperability will suffer until we have a picture that helps articulate and guide where we are going.”

Then there’s the question of whether even a decade-long vision might be too ambitious, given the recent exodus of top officials at ONC. As one commenter wrote beneath a Healthcare IT News article about that brain drain, “Will the 10 year plan turn into a 50 year plan because we are running it part-time?”

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