Key among those recommendations is that the Office of the National Coordinator for Health Information Technology and the CMS should take a new tack toward interoperability, pushing the use of so-called public application programming interfaces, essentially software that would allow various EHR systems to talk to each other and exchange data. “Public” means the software is available to anyone rather than being proprietary to one vendor.
The committees also called for requiring the use APIs in the Stage 3 meaningful-use criteria of the federal electronic health-record incentive payment program as leverage to ensure the APIs are adopted and used.
Inclusion of APIs in Stage 3 criteria, now being developed and scheduled to go into effect in 2017, should occur even if it means dropping other meaningful-use objectives, they said.
“We believe a narrow focus on interoperability is the way to go here,” said Micky Tripathi, co-chair of the Jason task force. “ONC and CMS should realign the meaningful-use program to shift focus to expanding interoperability and initiating adoption of public APIs. This is our most important recommendation.”
Tripathi is president and CEO of the Massachusetts eHealth Collaborative, a not-for-profit health information exchange.
Jason, a secretive group of scientists named after the mythical Greek hero, produced its 65-page report, A Robust Health Data Infrastructure, under a contract with the Agency for Healthcare Research and Quality, which released it in April. The Jason report called for the federal government to mandate development of a new “architecture” for health information exchange based on APIs.
Application programming interfaces are already the buzz in healthcare IT, with many organizations and EHR system developers using these bits of computer code to forge links to their EHRs, particularly with Web-connected services such as telehealth and home health monitoring, as well as mobile health applications.
Many of the APIs now used in healthcare facilitate the movement of electronic documents, such as care summaries, from provider to provider, or provider to patients.
In contrast, what the Jason task force recommended are APIs that can pluck single data elements in a patient's EHR, such as a single diagnosis code, as well as move documents.
APIs also could be used search, index and harmonize data, which would be useful for care coordination, population health management and research.
The joint Jason task force, while rejecting some of the scientists' recommendations, accepted others, including that current interoperability approaches based on the movement of electronic “documents,” are limited in scope and won't take the country where it needs to go to improve care, reduce costs and create a “learning healthcare system” of the future.
The task force also backed the Jason report's conclusion that the feds should use the Stage 3 meaningful-use requirements under its EHR incentive payment program to trigger a transition to the new system. And, the task force also backed the Jason report's key recommendation, that the foundation of interoperability should be an approach “modeled after the principles that have allowed the Internet to scale—a core set of tightly specified services that enable multiple heterogeneous ecosystems to emerge.”
The ONC, which the two health IT committees advise, recently estimated mobile health technology alone could trim $30 billion a year in wasted healthcare expenses.
The Jason task force suggested that work done by standards development organization Health Level 7 International in its Fast Healthcare Interoperability Resources initiative, “is currently the best candidate API approach to data-level and document-level access to healthcare data.” Implementations of the HL7 approach, abbreviated as FHIR, and pronounced “fire,” were demonstrated at the Interoperability Showcase section of the Healthcare Information and Management Systems Society trade show in Orlando this year.
Dr. Charles Jaffe, CEO of HL7 International, said interest in FHIR has developed over the past two years “because it works, it uses technology that everyone is familiar with and it's very, very easy to implement. That's the real key to this, the fact that it's not only an effective solution, but it's a very cost-effective solution. That's what makes it unique. You don't need a lot of enormous technical expertise. You don't need a lot of money, and you can achieve a really remarkable degree of interoperability with very modest skill sets.”
Follow Joseph Conn on Twitter: @MHJConn