Groups Praise, Question ONC’s Nationwide Interoperability Roadmap
April 6, 2015 in News
Various industry groups and stakeholders submitted comments on the Office of the National Coordinator for Health IT’s draft nationwide interoperability roadmap by Friday’s deadline for public comment, Health Data Management reports (Slabodkin, Health Data Management, 4/6).
The draft roadmap, titled “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0,” aims to achieve basic electronic health data interoperability by 2017.
Specifically, it outlines short- and long-term goals for the next 10 years, with 2017 set as the deadline by which “a majority of individuals and providers across the care continuum” should be able “to send, receive, find and use a common set of electronic clinical information.”
Specifically, ONC outlines four short-term actions:
- Clarifying privacy and security requirements needed to guarantee secure transmission, access and use of sensitive patient data;
- Enhancing incentives for achieving interoperability and data sharing goals that are based on a common clinical data set;
- Establishing a coordinated governance framework and process for nationwide interoperability based on stakeholder consensus; and
- Improving technical standards and implementation guidance for sharing data.
In addition, the document outlines 10 updated guiding principles for achieving nationwide interoperability over a 10-year period based on stakeholder feedback (iHealthBeat, 4/3).
The American Hospital Association in its comments said it supported ONC’s goal of creating an interoperable health IT infrastructure but raised concern about the roadmap.
Specifically, Linda Fishman, senior vice president of public policy analysis and development at AHA, said that hospitals and health systems have reported that recent electronic health record system technology does not support seamless data exchange.
Fishman added that “the cost and complexity of the many interfaces needed to connect systems today are simply not sustainable.”
AHA recommended that ONC mark the “starting point” of the interoperability roadmap, including:
- Current requirements under the meaningful use program; and
- The functionalities of 2014 Edition certified EHRs.
Under the 2009 economic stimulus package, providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments (AHA News, 4/3).
The American Medical Association in a letter to National Coordinator for Health IT Karen DeSalvo thanked ONC for its efforts to advance interoperability as a way to:
- Cut costs;
- Improve quality; and
- Support delivery and payment reform.
In the letter, AMA said the roadmap should focus on the immediate needs of patients and providers. Specifically, AMA recommended that ONC:
- Acknowledge the effect of the meaningful use program on interoperability;
- Address barriers to interoperability, including those related to costs and EHR usability;
- Avoid using a disciplinary approach on providers;
- Continue to foster private-sector governance efforts; and
- Prioritize “cornerstone” interoperability issues, such as functional standards and clinical data definitions (Madara, AMA letter, 4/2).
The Citizen’s Council for Health Freedom in its comments said that ONC should discontinue the interoperability roadmap, and instead should refocus its efforts on ensuring privacy.
The group said that HIPAA does not fully protect patients from unwanted data sharing, noting that “[t]he real answer to preserve the integrity of the health care system and the confidential patient-doctor relationship necessary for patients to trust and timely use the system — the sole purpose of the health care system — is to restore patient consent requirements over all sharing of patient data.”
Health IT Now Comments
Meanwhile, Health IT Now applauded ONC’s “ambition.”
However, the group raised concerns about:
- How ONC plans to change or align incentives in the face of regulatory limits in order to achieve its goals; and
- Whether some aspects of the roadmap are “desirable, achievable or attainable.”
The group said, “We are concerned the roadmap may become another document … that outlines ambitious goals, but achieves little, due to a lack of focus on attainable outcomes.”
In its comments, Imprivata — a provider of health IT security tools — urged ONC to focus on protecting health information within interoperable systems.
Specifically, Imprivata CEO Sean Kelly said that the exchange of data “relies on the integrity of health information,” which “can only be accomplished if the proper security policies, processes and technology measures are integrated at each step in the process — and if those security measures do not interrupt clinical workflows” (Gold et al., “Morning eHealth,” Politico, 4/6).
The Workgroup for Electronic Data Interchange praised ONC’s goals in the roadmap, but urged the agency to “better reflect” on the barriers to interoperability, as well as to better present opportunities for interoperability.
WEDI recommended that ONC:
- Create a list of priority actions and stakeholder assignments; and
- Continue to scale back direct federal oversight and “move toward coordination and guidance with private industry partners” (Health Data Management, 4/6).
Meanwhile, a group of several industry stakeholders in a joint letter said that ONC’s roadmap should incorporate patient-generated data and remote monitoring devices.
They wrote, “While the focus has remained on increasing the use of EHR systems, EHRs are but one key component of the larger effort to improve the American health care system … Patient-facing applications … must be considered when addressing interoperability.”
The group included:
- ACT | The App Association;
- The American Telemedicine Association;
- Christus Health;
- The Personal Connected Health Alliance;
- Telecommunications Industry Association; and
- Unilever (“Morning eHealth,” Politico, 4/6).