The U.S. healthcare industry, with appropriate and firm federal leadership in selecting and enforcing a core set of health information technology standards, should be able to achieve a widespread level of health information interoperability, but it will probably still take another a decade, Marc Probst, chief information officer at Intermountain Healthcare, told members of Congress.
Probst is a member of the Health Information Technology Policy Committee, which advises the Office of the National Coordinator for Health Information Technology at HHS as part of the rulemaking process for the federal electronic health-record incentive payment program created under the American Recovery and Reinvestment Act. The ONC, using the committee's input, has developed technical standards for the testing and certification of EHRs used by hospitals and physicians seeking to meet the meaningful use requirements of the EHR incentive payment program.
In his written testimony (PDF), Probst noted that under the federal initiative, progress toward data interoperability has been made, “but it is only a beginning. We must set a clear road map and support an exchange infrastructure and the adoption of standards that will make it easier to share health information so clinicians and patients have the information in the form and time they need it to make appropriate healthcare decisions. Presently, we lack a shared infrastructure and long-term plan to make this possible.
“The existing HIT systems,” he said, “be they vendor-developed or self-developed, also were built one by one and applied differing standards. Although very effective for each institution, heroics are required to share even basic data between them.
“Clearly, we have seen that volunteer processes can take decades to define and select standards—this is much of the problem and the basis for why I believe federal leadership is required for success,” Probst said. “If this is done, innovation in HIT will skyrocket, costs for interoperability and access to knowledge will be significantly reduced, and quality care across the country will improve.”
Probst said the focus on standards should be in seven areas—terminologies; detailed clinical models; a clinical data query language based on these agreed-upon models and terminology; security, including standard roles and standards for naming of types of protected data; interfaces; clinical decision support algorithms; and patient identifiers.
Success in transitioning to these standards “will require significant advanced planning, phasing and educational support of healthcare providers as they change systems and workflows,” he said. “My suggestion would be 10 years to give vendors, health systems and other developers the time to change technologies to meet these standards. 'Haste' is not wise in the health information technology arena.”
Also testifying, Willa Fields, the chairwoman of the board of directors of the Chicago-based Healthcare Information Management and Systems Society, said the success of accountable care organizations under the Affordable Care Act will depend on health information technology and praised the meaningful-use program, without which “we would not be nearly as far along this path to transforming healthcare as we are.”
Fields, a professor in the school of nursing at San Diego State University, said the government's “carefully choreographed three-stage meaningful-use program of health information technology criteria, electronic health-records certification, standards, and interoperability have resulted in a more rapid and orderly transition and faster adoption nationwide.”
Fields also said further adoption of standards for data transport, financial transactions, security and health information exchange is needed “as soon as possible,” along with the publication of both “the process and the schedule” for harmonizing those standards.
Subcommittee Chairman Rep. Ben Quayle (R-Ariz.) said the purpose of the hearing was to gauge progress made toward the development of health IT standards and to learn from witnesses what policymakers could do to advance interoperability. Quayle said he was concerned that the meaningful-use requirements “do not effectively take into account the complexity and diversity of the healthcare marketplace.”
Dr. Farzad Mostashari, head of the ONC, said the final Stage 2 meaningful-use requirements released last month “provide new flexibility in definitions, exclusions, a shorter reporting period for the first year of Stage 2, and additional quality measures that account for the needs of many medical specialties to measure and improve the care they provide.”
“We can now leap towards interoperability and exchange in Stage 2,” Mostashari said.