ONC Releases Final Nationwide Interoperability Roadmap
The Office of the National Coordinator for Health Information Technology today released its final Interoperability Roadmap laying out near-term, mid-term, and long-term goals to advance the safe and secure exchange of electronic health information nationwide.
Through the use of interoperable health IT, the roadmap seeks to enable the healthcare industry’s transition from the current fee-for-service model to a value-based model, according to National Coordinator for HIT Karen DeSalvo, M.D.
“If we’re going to change that business and care model, we’re going to need an information model for it,” DeSalvo said during a press conference. “In order to be able to understand the quality of care delivered for an individual and for populations, we need to have that data available.”
Consequently, the Interoperability Roadmap is a direct part of the Department of Health and Human Services’ delivery system reform initiative, she added. The final document is the result of months of stakeholder feedback received by ONC in response to a draft Interoperability Roadmap released in January.
Over the past six years since the HITECH Act, America’s healthcare system has established a foundation of electronic health records and “it’s really time for that data to be free,” said DeSalvo, adding that this will require “unblocking data that can move now and creating a clear glide path for more seamless system and data interoperability.”
Toward that end, the document lays out a phased timeline with corresponding goals for achieving the interoperable exchange of electronic health information:
• 2015-2017:Send, receive, find and use priority data domains to improve health care quality and outcomes.
• 2018-2020:Expand data sources and users in the interoperable health IT ecosystem to improve health and lower cost.
• 2021-2024:Achieve nationwide interoperability to enable a learning health system, with the person at the center of a system that can continuously improve care, public health, and science through real-time data access.
To be successful, DeSalvo said there are several major components to the Interoperability Roadmap that must be implemented. “We know that we need to have the right business case or set of economic incentives to create not only the push but the pull of data,” she asserted, as well as “moving to federally-recognized national interoperability standards that would relate to technology and also policies including privacy and cybersecurity.”
Lee Barrett, executive director of the Electronic Healthcare Network Accreditation Commission (EHNAC), a voluntary, self-governing standards development organization created to develop standard criteria and accredit organizations that electronically exchange health data, argues that there has been very limited progress in the area of interoperability and that vendors—in part—are to blame.
“There are several reasons why the needle has not moved. One is that the vendors themselves continue to have the same attitude that they’ve had for years, which is a proprietary one: ‘we’re sticking with our proprietary platforms and we’re not going to make it easy for entities to be able to interface with us to get data either in or out of systems easily,’” says Barrett, who adds that “none of the vendors want to take the potential risk that their revenue would be impacted.”
ONC has “laid out a fairly good overall roadmap,” comments Barrett, “a little light in the aspect of how to get there, but at least a framework for the next 10 years.” He says what’s missing is “figuring out how we’re going to create the right type of national exchange and connect up all these various stakeholder points.” What’s needed, he adds, are quantifiable results in the form of technology pilots to demonstrate what can be achieved with standards-based interoperability.
In her press briefing, DeSalvo referenced Health Level Seven International ‘s Fast Healthcare Interoperability Resources (FHIR) framework, which leverages the latest web standards and is supported by EHR vendors such as Epic and Cerner and health systems like Mayo Clinic and Intermountain Healthcare.
Barrett agrees that FHIR has “tremendous potential” in addressing the lack of health IT interoperability that plagues the healthcare industry. “We need to validate if FHIR is the right format and foundation to get behind,” he concludes. “If it is, then let’s make that decision and move forward and start building around it.”
Premier Inc., a healthcare alliance of 3,000 hospitals and 110,000 other providers, sees ONC’s roadmap as a “significant leap forward” in the national interoperability effort.
“We strongly believe that this roadmap will provide important guidance that will help improve consumer access to health data and the sharing of electronic health information among providers,” said Blair Childs, Premier’s senior vice president of public affairs. “We also support the roadmap’s recommendations for broader, governmental action to promote consistent, national interoperability standards, including the use of open source application programming interfaces to support the secure transfer of information between and among different HIT platforms.”
Likewise, the Healthcare Information and Management Systems Society supports the roadmap’s “focus on using consensus-based standards, enabling the shift in payment policies from fee-for-service to value-based models, and aligning federal and state privacy and security requirements that enable interoperability,” according to Carla Smith, executive vice president of HIMSS North America.