While the Office of the National Coordinator for Health IT’s draft Interoperability Roadmap attempts to define a framework for interoperable electronic health records, five Republican Senators charge that the document is heavy on generalities and light on specifics.

“The ONC roadmap provides a framework for responsibility, governance, and accountability in regard to the future development and implementation of interoperable EHRs. But instead of offering specific objectives, deadlines, and action items, ONC’s roadmap falls short on the nitty gritty technology specifics that vendors and providers need when developing IT products,” write Senators Lamar Alexander (R-Tenn.), Richard Burr (R-N.C.), Mike Enzi (R-Wyo.), Pat Roberts (R-Kan.), and John Thune (R-S.D.) in a blog published by Health Affairs.

“ONC proposed high-level goals for how to achieve interoperability, like building on existing infrastructure and empowering individuals, but the roadmap fails to outline real and actionable next steps,” state the senators. “It is not enough for ONC to identify factors it believes are important. It must also delineate how it will find specific solutions to these concerns.”

They go on to say: “High-level ideas are important, but we are concerned that without specific requirements and action items, we will not advance towards the goal of improving health care coordination and patient care, which was the intent of the HITECH Act.” As a result, they say “we are left with many outstanding questions about how to achieve interoperability and how to address the cost, oversight, privacy, and sustainability of the meaningful use program.”

Erica Galvez, ONC’s Interoperability and Exchange Portfolio Manager, agrees that the governance framework and “rules of the road” in the Interoperability Roadmap are meant to serve as a set of “high-level principles.” However, Galvez tells Health Data Management that ONC has no intention of “getting to the really granular details” in that type of framework. That level of detail is “what should be handled through the industry-led process that we called for in the roadmap” and “we think industry should be on the hook to carry out a collaborative process where they make decisions about detailed implementation pieces,” she adds.

Yet, it isn’t just ONC’s Interoperability Roadmap that falls short, according to the senators. They also point to a steady stream of other disappointing high-level documents on interoperability: the JASON reports, the Health IT Policy and Standards Committees’ reports, the Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure report, and the Federal Health IT Strategic Plan 2015-2020 report.

“All of these reports, as well as the ONC’s latest roadmap, are missing the same thing: practical and actionable steps to ensure a proper return on the American people’s investment,” argue the senators.

The blog points to the lack of progress toward interoperability as the key reason for the “lackluster performance” of the HITECH Act’s stimulus. Despite spending $28 billion to date of a total taxpayer investment of $35 billion, significant progress toward interoperability has been elusive, according to the senators.

“Stage 1 of the meaningful use program failed to include any meaningful health information exchange requirements, and lacked a vision to achieve interoperability,” they assert. “Instead, Stage 1 incentivized the widespread adoption of EHR systems that providers now say are difficult to use and lack the ability to exchange information without costly upgrades. We are now well into Stage 2 of the Meaningful Use program and providers are struggling to meet even modest health information exchange requirements.”

The Senate Health, Education, Labor, and Pensions Committee, which is chaired by Alexander, was scheduled to hold a March 5 hearing on “America’s Health IT Transformation: Translating the Promise of Electronic Health Records Into Better Care.” However, it was postponed. Despite the delay, Alexander and his colleagues will no doubt keep the interoperability of EHRs on their legislative agenda in the new Congress. 

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