Five pillars of electronic health record implementation--adoption, standards, privacy/security, incentives, and governance--are required to ensure interoperability, according to Doug Fridsma, M.D., ONC's chief science officer and director of the Office of Science and Technology. Fridsma, a keynote speaker at a Feb. 23 HIMSS14 pre-conference symposia, argued that meaningful use Stages 1 and 2 have helped to promote medical data interoperability but much work remains to be done.      

"Meaningful Use is about interoperability. It's about adopting technology and then demonstrating interoperability through exchange and use of the information," said Fridsma, who believes that "appropriate" EHR standards are critical, as well as ensuring that these standards are being used effectively. Privacy and security are also essential components of interoperability "because people aren't going to exchange data that they don't trust."

In addition, he advocated for business drivers in the form of clinical incentives, and the ability to sustain interoperability through the establishment of some structure of governance. Yet, Fridsma warned that health I.T. is not a "one-size-fits-all" solution. Instead, he said that it requires a portfolio of solutions with interoperability based on an incremental approach.

"We have to realize that we cannot let perfect to get in our way," said Fridsma. "We will never develop interoperability solutions in a committee. We'll never do it in a hearing. We won't do it in a pilot. But, we will do it when we get it out there in the real world and people start to use the standards that are out there."

The HITECH Act provided $2 billion to ONC between 2009 and 2013 to support health I.T. infrastructure, policy and standards, education and other activities. However, Fridsma lamented to the HIMSS14 audience that ONC's budget had returned to its historic funding level of $60 million annually--the same amount the office received when it was formed in 2004. Despite financial and other challenges, he claimed that the pace of change from a fundamentally paper-based system to EHR is one that is unstoppable.

"If you look at the various ways that ONC has been trying to get there, technology is an important part of it but there's also policy and other aspects," remarked Fridsma. "If you ask the technology folks what the barriers are to interoperability, they will tell you it's all those policies and business practices. If you ask the business folks, they'll say it's the technology that's the problem. Both people blame the other side but there's a shared responsibility for getting this done."  

"Stage 1 with adoption we're making good progress. With Stage 2, I think the jury is still out," he added. "The way that we get our work done is through the standards and interoperability framework. It's a way for us to invest in where the bottlenecks are to achieving consensus and getting people together to solve some of these really hard challenges that we've got." 

On Friday, ONC issued proposals for the 2015 edition of EHR technology certification criteria, marking the first time it has proposed an edition of certification criteria separate from the Centers for Medicare & Medicaid Services’ meaningful use regulations. According to ONC's announcement, compliance with the 2015 edition is voluntary--EHR developers that have certified EHR technology to the 2014 edition would not need to re-certify for customers to participate in the Medicare and Medicaid EHR Incentive Programs.

In addition, healthcare providers eligible to participate in the Medicare and Medicaid EHR Incentive Programs would not need to “upgrade” to EHR technology certified to 2015 edition to have EHR technology that meets the Certified EHR Technology definition. 

The proposed 2015 edition rule will be published in the Federal Register on Wednesday, Feb. 26, and ONC will accept comments through April 28. The final rule is expected to be issued this summer.

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