As the Interoperability and Exchange Portfolio Manager in the Office of the National Coordinator for Health IT, Erica Galvez is leading the charge at ONC to achieve nationwide interoperability to support higher quality, more affordable care and better health outcomes for all Americans.

Toward that end, ONC on Jan. 30 issued a draft Interoperability Roadmap, detailing its vision and path forward for both the public and private sectors to create a health ecosystem.

Health Data Management spoke with Galvez about the roadmap and ONC’s broad vision and framework to develop a pathway to interoperable health IT in this country.


HDM: What is your definition of interoperability?

Galvez: It’s always important to start with definitions. So, in a formal sense, we define interoperability as the ability of two or more systems to exchange and use information without special effort on the part of the user. That’s derived from the IEEE definition. It’s not exactly their definition but it aligns very closely.

When we say “use” as part of that phrase, I think it’s important to note that we’re really talking about the capability of a system to process and parse information and then put it into a user interface in a manner that the customer can actually use and doesn’t have to do manual data entry--and all that kind of cumbersome stuff. We’ve tried in both our interoperability vision paper and the Interoperability Roadmap to add some color to that--to add some language that helps the less technical and lay audiences to understand what that would look like.

So we talk about that meaning in the real world the ability for people to have information that they need, when they need it, and in a manner that they can use it. There’s an aspect of timeliness to that. There’s an aspect of access to a broad set of information, because the information that a person uses for a particular decision-making activity may vary by person. And, so over the long haul, this view of a learning health system really would make a pretty broad range of information available securely--respecting an individual’s privacy--but making that available when and where it’s needed in a manner that’s useful to the user.

HDM: What is the current state of interoperability of health IT in this country, or lack thereof? Where are we at as an industry and where do we need to go?

Galvez: It’s really hard to measure interoperability, so it’s hard for me to give you one really crisp, clear answer to that question. I’ll maybe parse it a couple of different ways. If we think about the definition of interoperability, one component of that is the exchange of information--the movement of information--and then another component being the ability to use it, which really gets to a level of semantic interoperability that is key.

We know that we have a lot of health information exchange happening and a lot of it happening electronically. It tends to happen in certain pockets defined by different boundaries—many times defined by geography, in part because the laws and regulations that govern how health information can be moved electronically or otherwise tend to be issued at a state level. And, so that creates natural clusters that happen to align with geography.

We also tend to see success where there is a really clear network infrastructure—both in a technical sense and in a policy sense where there is a clear governance mechanism. We see this with the CommonWell Health Alliance, for example, and the nationwide eHealth Exchange. Those aren’t really bound by geography but they are bound by kind of a governing body and a set of very specific participants that participate in that governing process to make decisions not only about policy but about technically how we are going to share information. I think we also see now with the electronic health records meaningful use program, and Stage 2 in pretty full swing, a fair amount of—not interoperability—but exchange happening across providers who are eligible for that program and using certified technology.

I hesitate to call all of this interoperability because I think what we see in a lot of these cases—we hear this a lot about Stage 2 transactions—is that yes, it’s based on a Consolidated CDA care summary and it moves electronically between two systems, but the reality is it can’t be parsed and processed on the receiving end without intervention by a person and special effort on the part of the user. And, that is part of our definition and our threshold for interoperability.

HDM: So, what I hear you saying is that the draft Interoperability Roadmap is aimed at nationwide interoperability, regardless of geographic and organizational boundaries, correct?

Galvez: That’s exactly right. It’s something that I’m not sure folks really understood when we first brought forward draft material to our federal advisory committees in October of last year. I think it’s something that people are starting to understand now and they’re starting to understand how ambitious that is. It’s a scale thing. We’re not talking about just pockets of success in a certain number of states or a certain number of networks. We really are talking about nationwide interoperability.

We have a vision and associated goals for three-, six-, and 10-year timeframes. For each of what we call functional or business requirements for a learning health system, within each of those categories we have critical actions identified for each of those timeframes. These are things that we think need to happen in that particular timeframe to achieve the goal that we’ve associated with that timeframe, but that also puts us on a path toward the learning health system—which is that 10-year longer term trajectory.

HDM: Looking at the goals for the three-, six- and 10-year timeframes, they seem very ambitious but are they achievable?

Galvez: We think it is doable. We don’t think it is doable with government action alone. But, we do think it’s realistic. For the three-year timeframe, which is pretty near term and not that far away, we should be in a place nationwide where the majority of care providers and the majority of individuals—and we use the term individuals in the roadmap to refer to consumers—should be able to send, receive, find and use a very discrete set of health information that we describe in the roadmap.

We have not said the majority should be able to find every single piece of their health record—that might be overly ambitious and perhaps not achievable. But, if all the different sectors of our health IT ecosystem really pull together and work in harmony, yes we think we actually can in the next three years get to a place where the majority of providers and individuals are able to send, receive, find and use that core set of health information.

HDM: So, the ultimate goal is a learning health system?

Galvez: That is the goal that we’re working toward. We don’t focus on interoperability just for the sake of interoperability. That would be an error. Interoperability propels us toward much larger goals like healthy people—having a healthy population—and making sure that our care delivery system provides the highest quality and safest care possible, as well as making sure that we spend our healthcare dollars wisely.

A learning health system is an environment that enables all of those things, and it does that by creating these closed loops of information—a seamless flow of information not only within the care delivery system but across a number of different segments of society and our communities. Because the reality is the vast majority of factors that influence a person’s health operate outside the care delivery system. If our big goal is healthy people and we think only about the care delivery system, we’re missing huge opportunities to help people be healthier and make better informed, evidence-based decisions by having access to a broad range of relevant and accurate information.

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