The Office of the National Coordinator for Health IT has established the ambitious goal of connecting the nation’s health information exchanges—both public and private—by the end of 2016 to make a big push toward nationwide interoperability.    

“We have built—through the hard work of the private sector, states, and support from the HITECH Act—an infrastructure in this country where essentially every state has a health information highway,” said National Coordinator for Health IT Karen DeSalvo, M.D. “Our goal is to see that we can connect those highways—including the health information exchanges but also the private sector exchanges—in the entire country within a year.”

Speaking on Tuesday at the Bipartisan Policy Center in Washington, D.C., DeSalvo made the announcement to connect HIEs across state lines as part of ONC’s 2016 priorities. “That lays the foundation that we can build upon year over year to add more information to see that it can flow.”

Her vision for interoperability is one in which “we have secure but seamless data exchange where electronic health information is unlocked and widely shared in order to get to better care, smarter spending, and healthier people,” she said. “That information is going to be available to doctors in real time so that they will be able to address the clinical needs of their patients.”

In describing the kind of open and integrated healthcare system that will connect communities, DeSalvo gave the example of “when your mom falls when she’s visiting you in D.C. for the holidays, her doctor back in Texas gets a notification right away or when she gets transferred or discharged from the hospital that same notification goes out.”   

According to DeSalvo, implementing shared standards for interoperable electronic health records that are “federally-recognized but nationally-developed by the private sector” will advance the kind of innovation necessary to achieve interoperability. One such emerging potential standard that she referenced is Health Level Seven’s Fast Healthcare Interoperability Resources (FHIR) framework for information sharing based on the latest web standards.

“We have been working with the private sector through a series of ‘hand-offs’ to advance the notion of these application programming interfaces (APIs)—these doorways to the data,” said DeSalvo, who added that HL7’s Argonaut Project—aimed at accelerating development and adoption of the FHIR API—are the kinds of systems interfaces that “will allow these doorways to the data to be opened more quickly, seamlessly, and in a way that is more public and transparent.”  

She pointed out that ONC’s recently released 2015 Edition Certified EHR Technology rule requires vendors to provide access to a Common Clinical Data Set via an API in their new products by 2018. To support this requirement, DeSalvo said that ONC will be working with the private sector to develop a prototype app store “one that—for lack of a better term I’m calling today the ‘FHIR Cloud’—a place where if I want a better user interface for my system or I want a way to access my immunization records, I can go download that app.”   

Also See: Assessing the Privacy, Security Vulnerabilities of APIs

In addition, DeSalvo revealed that ONC is working through its certification program to address the problem of health information blocking. “We have new expectations that will begin just next month on the vendors and IT developers that’s going to require more transparency and more openness about what it is people are buying,” she announced. “When you purchase an IT product, especially if you are a small practice doctor, you don’t always know what’s included in the price. We want to overcome that.”    

When it comes to EHR usability, DeSalvo acknowledged that systems “still feel clunky and it’s hard to not only put in data but to extract data.” While the use of EHRs in the clinical environment has tripled in a few short years, she believes that true interoperability will “require us to make systems more usable, to connect the systems that already exist, and to see that we’re unlocking that data so that it can be put to the uses we all want and give us the return on investment that we all desire.”

Despite the federal government’s investment of more than $30 billion in EHRs, nationwide interoperability across care settings has yet to be achieved, according to Janet Marchibroda, the Bipartisan Policy Center’s director of health innovation. Marchibroda said that while EHR adoption among providers “is going through the roof” a mere 9 percent of doctors share information electronically with unaffiliated hospitals and only about 26 percent of physicians share information electronically with other ambulatory care providers.

“We’ve got the systems in the offices but we need the information to be shared,” she lamented.

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