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ONC sketches 10-year blueprint for interoperability


By Darius Tahir
Posted: June 5, 2014 - 6:45 pm ET
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The ONC blueprint to encourage interoperability between medical records and other sources of health information foresees using five tools: standards; certification testing electronic health-record compliance with such standards; privacy and security standards; supportive business, clinical, cultural and regulatory environments; and rules of engagement and governance. The blueprint (PDF) was released Thursday.

The goal, the report from the Office of the National Coordinator for Health Information Technology says, is to enable better information sharing. The intention is to allow easier exchange of relevant patient information between various players in the healthcare system, and foresees the increased use of alternative payment models as a key motivator.

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Among its other ambitions, the report foresees more “patient-centered outcomes research,” increased use of “clinical decision support” incorporating data on “an individual's genetic profile, local trends in disease prevalence, antibiotic resistance, (and) occupational hazards,” easier clinical trial recruitment and “dramatically improved” public health surveillance “through better outbreak detection and disease incidence and prevalence monitoring.”

But many of these goals are, by the report's reckoning, 10 years in the future. To transform present capabilities into future aspirations, the report proposes starting with standards that ensure a common data vocabulary and provenance, as well as common methods of accepting and transporting data.

It envisions seven “essential services for interoperability” supported by standards: methods to accurately match individuals, providers, and their information across sources; directories of the “technical and human readable end points for data sources” so it's discoverable; methods for authorizing and authenticating users when they want to access data; methods for securing data; methods for representing data “at a granular level to enable reuse”; and methods for handling information in structured and unstructured formats.

Those standards would then be used by the agency's certification program to ensure EHRs conform. But, the report concedes, while meaningful use has been a “primary motive” for adopting certified EHRs, it won't suffice to achieve full interoperability.

The report envisions using new payment models to further encourage use of health IT, stating, “HHS will consider ways in which the adoption and use of ONC-certified health IT products can be aligned with and encouraged by Medicare and Medicaid payment policy, and other HHS programs funding healthcare delivery so that care delivery transformation and interoperability evolve in tandem.”

But the agency is also mindful of risk and pitfalls for achieving interoperability. One example, it notes, is privacy—creating the appropriate level of trust in patients and providers to use data in ambitious ways. “Our governance approach must consider a common framework for privacy, security, technology, data and business practices.”

Dr. Joe Smith, the chief medical and science officer of West Health Institute, a medical research institute encouraging interoperability, praised the report's vision as a “massive opportunity,” and specifically praised its recognition of device-EHR interoperability, saying, “Our long-term vision is for automated, coordinated and connected care made possible by the seamless flow of information regardless of its source to wherever it can be used for the patient's benefit.”

Follow Darius Tahir on Twitter: @dariustahir


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