The Office of the National Coordinator for Health IT on Wednesday discussed “early strategic elements” of a draft roadmap for achieving a nationwide interoperable HIT infrastructure based on input from industry stakeholders.

The draft roadmap, presented during a joint meeting in Washington of ONC’s Health IT Policy and Standards Committees, is designed to “bring this nation to a place where we’re moving well beyond collection of data--digitizing the healthcare experience--and beginning to share it so we can see the return on the investment,” according to National Coordinator for HIT Karen DeSalvo, M.D.

Erica Galvez, ONC’s interoperability and exchange portfolio manager, presented the draft roadmap--described as a living document--to the committees with key near-term actions and milestones tied to three-, six-, and 10-year goals. In June, ONC released a paper with its 10-year vision for interoperability, inviting stakeholders to join the agency in developing a defined, shared roadmap to collectively achieve health IT interoperability.

For this “first cut” of the roadmap, Galvez emphasized that ONC has focused on goals and high-level requirements, listing specific health IT ecosystem goals for providers, individuals and population/public health in the 2014-2017, 2017-2020 and 2020-2024 timeframes, respectively. The draft roadmap, which will be available for public comment in January 2015, lays out an incremental process for achieving interoperability with a three-year agenda (providers and individuals send, receive, find and use a basic set of essential health information), six-year agenda (use more granular information to further improve health care quality and lower cost), and ten-year agenda (learning health system for population health with broad access to longitudinal information).

Galvez said ONC has adopted the Institute for Electrical and Electronic Engineers definition of interoperability: the ability of a system or product to work with other systems or products without special effort on the part of the customer, which is made possible by the implementation of standards. But, she asserted that prevailing wisdom is that national standards not be adopted until they are fully tested and matured. Toward that end, the draft roadmap is structured around five building blocks for a nationwide interoperable health IT infrastructure:  core technical standards and functions; certification to support adoption and optimization of HIT products and services; privacy and security protections for health information; supportive business, clinical, cultural and regulatory environments; and rules of engagement and governance.

“We have seen a tremendous uptake of electronic health records and we have reached critical mass, as Dr. DeSalvo pointed out in her opening comments,” said Galvez. However, a report released earlier this year conducted by JASON, an independent group of scientists advising the federal government, found that the current lack of interoperability among data resources for EHRs is a major impediment to the “unencumbered exchange of health information and the development of a robust health data infrastructure.” According to the report, interoperability issues can be resolved only by establishing comprehensive, transparent, and overarching software architecture for health information.

In response to the draft interoperability roadmap, the Health IT Now Coalition commended ONC and DeSalvo for issuing a call to action that “immediately challenges the status quo to think beyond pecuniary interests to transforming healthcare.” Given that the problems that exist in interoperability are largely understood, Health IT Now Coalition executive director Joel White argued that the “dialogue should now transition to how we best achieve interoperability” which “should be done as quickly as possible” and the Health IT Policy and HIT Standards Committees should “step up” to take charge and demand better results for patients. “The question is whether we let the proponents of the status quo continue to dictate health IT policies that don’t work for most Americans,” said White.

ONC’s draft interoperability roadmap is available here. Version 1.0 of the roadmap will be completed in the spring of 2015.

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