ONC Envisions Interoperable Health IT Infrastructure by 2024

The Office of the National Coordinator for Health Information Technology on Thursday released a paper outlining its 10-year vision for achieving a nationwide interoperable health IT infrastructure.

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Comments (2)
I've been involved with the interoperability issue since the Federal government's ONCHIT call for proposals, ten years ago, for the National Health Information Network (NHIN). At that time my company submitted a proposal for a secure, economical solution for the exchange of health information between patients, providers, researchers, and public health agencies that uses encrypted e-mail over the internet (SMTP with S/MIME) in peer-to-peer, publish/subscribe mesh node networks.

For the past decade, we have been working diligently for the realization of this vision. We have, for example, participated as committed members in ONC workgroups (i.e., Direct project, S&I Framework initiatives, and 360X); written to Congress; engaged with patient privacy rights groups; replied to requests for information; and developed software applications able to demonstrate the viability of our proposed interoperability solution.

Sadly, it has been a struggle all the way for political and business layer reasons (not for technical reasons).

Nevertheless, there has been recent progress in the right direction, such as MU2's requirement for the Direct project's "Simple SMTP" transport capability and for the use of data standards (e.g., C-CDA).
Now, while ONC's recent publically stated commitment to interoperability is a step in the right direction, I agree with Joel White assertion that too much time (and money) has been wasted and there is no need to wait another 10 years for interoperability. Given the political will, it can be achieved in just a couple of years, at minimal cost, using technology that already exists, such as e-mail clients and PKI.

It appears to me that the biggest challenges to interoperability include:

- EHRs vendors that do not want to share patient information they store with authorized parties that use other EHRs and thus refuse to comply with the MU2 requirements

- Use of transport methods that do not adequately protect patient privacy by allowing the encryption of PHI to break as it passes from sender to receiver

- Regulatory capture that stifles creative destruction through regulations that block disruptive innovation and that fail to support such innovations financially.
Posted by Stephen B | Friday, June 06 2014 at 10:37AM ET
I hope that ONC will be promoting the importance of testing for interoperability and standards conformance in the electronic exchange of health information. ONC has the opportunity to mobilize the community to participate in the building and testing of open source interoperability solutions.

Some proposed objectives to consider to ensure ONC's vision of Interoperable Health IT Infrastructure by 2024 include:
- Support Automated Platform for Test Case Execution
- Document Best Practices for Audits and Work Flow Lifecycle of Testing
- Supports an Environment for Re-Use of Testing Tools/Test Cases
- Promotion Beyond "Happy Path Testing (peer-to-peer), ensure Negative Testing"
- Promote Industry Reporting Metrics on how well their products and services ensure interoperability and not vendor lock-in.
Posted by BID1919 | Wednesday, June 18 2014 at 9:46AM ET
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