Healthcare IT community leaders are reacting favorably to the government's new plan to improve the interoperability of health information technology systems.
“I think the overall tone is very positive,” said Jennifer Covich Bordenick, CEO of the eHealth Initiative, a Washington, D.C.-based promoter of health IT. “We want to make sure this is a public-private effort. The government can't do this alone and that sounds like what we're aiming for.”
Russell Branzell, CEO of the College of Healthcare Information Management Executives, a professional association of hospital CIOs, said, "This is a much-needed playbook for each and every health IT professional. Now, healthcare providers and health IT developers have a single source of truth, with an extensible process to align clinical standards towards improved interoperability, efficiency and patient safety.”
Dr. Joseph Smith, chief medical and chief science officer for West Health, LaJolla, Calif., research organization, think tank and incubator of innovative health information technologies, sees a vital element missing from the plan—interoperability of information from computerized medical devices. The plan addresses information being exchanged between the devices and EHRs, but not device-to-device interoperability, which would benefit patients, Smith said.
“I think it's essential to make sure as we push on interoperability we need to make sure we leave no information source behind,” Smith said. “Medical devices that surround critically ill patients, that piece still needs to be wrapped in if this is to be an interoperability framework that handles all the issues.”
The 164-page plan, officially called Connecting Health and Care for the Nation, A Shared Nationwide Interoperability Roadmap, was released Friday morning by the Office of the National Coordinator for Health Information Technology.
A 13-page “Interoperability Standards Advisory” was also released. It lists what the government considers to be the best standards and implementation specifications for various health information exchange activities.
The ONC plan is “very ambitious,” said Robert Tennant, senior policy adviser for the Medical Group Management Association. “Certainly the timeline is very ambitious, but absolutely critical.”
The road map set a national goal of having providers able to exchange a common set of clinical healthcare data by 2017. It also called for an overarching, national governance capability to set and enforce “rules of the road” for a proposed nationwide health information network.
Jodi Daniel, a lawyer and ONC's director of the Office of Policy Planning, said at a news conference Friday to announce the plan that everything is on the table when it comes to enforcing those rules.
“We are considering regulatory options to ensure accountability,” Daniel said.
But the governance model the ONC is looking for is what the road map describes as “non-governmental governance.”
ONC chief Dr. Karen DeSalvo reinforced that theme, saying healthcare industry participation in the governance model was essential, while a governance process is “desperately needed to scale trust and scale interoperability” across a nationwide system.
The plan's focus on collaboration with a public/private governance authority is good, said Lee Barrett, executive director of the not-for-profit Electronic Health Network Accreditation Commission. The commission, commonly known as EHNAC, certifies health information exchanges for organizations.
“There is a need for a third-party review,” Barrett said. “The ONC, or the government, is not going to take on that enforcement role. They're looking for the industry to self-police. They want organizations to work with them and the industry to develop the criteria we'll all use.”
Several organizations, including eHealth Initiative and the Workgroup on Electronic Data Interchange, have developed interoperability road maps on their own, Barrett said, so the government's role will be to bring those efforts together.
“We have a lot of momentum,” Barrett said. “We have a lot of factions with different plans. But all of this has to come together. The appropriate role for government is to facilitate, not what I call mandate.
“If they can get the players to execute to the vision they have” and contribute their own ideas, Barrett said, “that's a good role for the government to take, that of convener and facilitator.”
The shift by both government and private-sector payers to accelerate the use of outcomes-based reimbursement methods is the driving force behind the federal emphasis on interoperability. HHS Secretary Sylvia Mathews Burwell announced Monday that the CMS wants 30% of Medicare payments linked to outcomes-based reimbursements by 2016.
“The transitions to the new payment models are really putting everyone's backs to the wall,” Brodernick said. “The demand to move to these new payment models is tremendous and the only way we're going to get there is we have to have access to the data—and we don't have that right now. It's forcing the issue, and that is a good thing for patients. It means that the data will be there for patients when they need it.”
Branzell said he likes the plan's focus on trying to lead the industry to adopt common standards and implementation specifications for electronic data transactions.
“While we have made great strides as a nation to improve EHR adoption, we must pivot towards true interoperability based on clear, defined and enforceable standards," he said.
“We're absolutely committed to interoperability,” said Zane Burke, president of Kansas City, Mo.-based Cerner Corp., who agreed it needs to be a national priority. “As an industry, we need to come together to figure out how we communicate” not only between providers, but also with patients.
“The other piece that's going to be crucial is the role of certification,” Tennant said. “It's one thing to have voluntary standards, but if nobody adheres to them, we won't achieve success. They're looking at a combination of private-sector and public-sector certification. Folks like EHNAC have stepped up” and created a testing and certification program for health information exchanges.
Promoting that sort of testing program “is going to be absolutely essential if we're to achieve interoperability,” Tennant said.
Follow Joseph Conn on Twitter: @MHJConn