ONC Issues Roadmap for Health Information Interoperability

HHS’s Office of the National Coordinator for Health Information Technology (ONC) released a draft Roadmap setting forth timelines for specific actions aimed at achieving interoperability of health care information. The Roadmap seeks to implement the “vision” expressed in the ONC’s June 2014 concept paper, “Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure.” The ONC’s Roadmap advises patients, providers (including hospitals, laboratories, pharmacies, and other providers), payers, government, and researchers on the steps necessary to ensure health care information is available and accessible to all involved in health care delivery. The ONC defines interoperability in the Roadmap as “the ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user.” The objective is to make health care information electronically available and promote patients’ active involvement in their health care, well-informed decision making, and coordinated delivery of care. Covering a 10-year period, the Roadmap is subject to revision and will be updated every two years. Comments on the draft are due by April 3 and then ONC will issue a revised Roadmap. Getting the Right Information at the Right Time The Roadmap espouses a “learning health system” that engages all stakeholders across health care including government, public health services, individual providers, hospitals, laboratories, researchers, and community organizations. “A learning health system also incorporates advanced health models that increasingly leverage technology, such as telecommunications technology to deliver health and clinical services remotely, that improve access to care across clinical and non-clinical community settings.” Similar to the concept of the “right test at the right time” that we hear so much about in the clinical diagnostic testing environment, the Roadmap calls for an “interoperable health IT ecosystem” that focuses on the individual and “makes the right electronic health information available to the right people at the right time across products and organizations, and in a way that can be relied upon and meaningfully used by recipients.” The timeline set forth in the current draft seeks to have all stakeholders able to “send, receive, find, and use a common set of electronic clinical information at the nationwide level by the end of 2017.” Hurdles to be Overcome The draft Roadmap highlights barriers to interoperability, namely: 1) the fact that even accessible data can’t always be easily received and processed in a meaningful way; 2) lack of harmonization among laws affecting health information, misconceptions about laws affecting health information sharing, and a need for financial motivations promoting interoperability; and 3) the absence of a method for ensuring information sharing “across disparate networks nationwide.” The Roadmap solicits a “common set of policies and technical standards.” Addressing one of those barriers—laws affecting health information, the Roadmap addresses how misperceptions about Health Insurance Portability and Accountability Act (HIPAA) requirements impede sharing of information permitted under HIPAA. It also criticizes the fee-for-service payment model as another barrier to achieving interoperability and calls for government and private payers to develop payment policies that incentivize information sharing and reward quality rather than quantity of services. To achieve national interoperability, the Roadmap says four actions must be taken by public and private entities: (1) establish a coordinated governance framework and process for nationwide health IT interoperability; (2) improve technical standards and implementation guidance for sharing and using a common clinical data set; (3) enhance incentives for sharing electronic health information according to common technical standards, starting with a common clinical data set; and (4) clarify privacy and security requirements that enable interoperability. It provides a series of timelines for action for different stakeholders that covers 2015 through 2020. Standards for Interoperability The ONC also issued a draft Interoperability Standards Advisory (the 2015 Advisory) discussing “the best available interoperability standards and implementation specifications” and addressing “clinical health information technology (IT) interoperability.” The Advisory doesn’t address transactions relating to payment, nor does it address HIPAA regulations and activities falling within their scope. Like the Roadmap, the Advisory is a draft expected to be updated annually. Public comments concerning the draft Advisory are solicited and must be submitted by May 1, 2015. The selected standards and specifications discussed in the Advisory were chosen according to several factors including current usage of the standard or specification to comply with existing regulations or by federal agencies in the eHealth Exchange, existing use by many stakeholders, and current availability of the standard or specification. Selected “best standards” in future drafts of the Advisory could also include new standards or specifications if they aren’t subject to ongoing changes or undergoing “fixes.” For more information and to review the 166-page draft Roadmap and the draft Standards Advisory, visit the ONC’s website at www.healthit.gov/interoperability. Sources Office of the National Coordinator for Health Information Technology, “Connecting Health and Care for the Nation, A Shared Nationwide Interoperability Roadmap,” Draft Version 1.0 (Jan. 2015). Office of the National Coordinator for Health Information Technology, “2015 Interoperability Standards Advisory,” (Open Draft, Jan. 2015). Takeaway: HHS’s goals and timeline for interoperability and health information sharing overlap with emphasis on value rather than volume of services.