Feds set 2017 goal for interoperability

Federal health information technology policymakers will turn up the pressure this year on healthcare providers, electronic health-record systems developers and health information-exchange operators to connect their computer systems and share patient data across the nation.

The coming push for nationwide interoperability was laid out last week in a 164-page plan titled “Connecting Health and Care for the Nation, A Shared Nationwide Interoperability Roadmap,” issued by HHS' Office of the National Coordinator for Health Information Technology. It calls for most healthcare providers to be able to use their systems to send, receive and use “a common set of electronic clinical information … at the nationwide level by the end of 2017.” It also sets a goal to achieve data-sharing levels essential to a “nationwide learning health system” by 2024.

The common data set that ONC proposes consists of about 20 basic elements, such as patient demographics, lab test results and identifiers for a patient's care team members. Accompanying the 10-year interoperability plan is a 13-page “advisory” to the health IT community on what the feds see as the best available healthcare information exchange standards and implementation specifications for data swapping.

Some health information already is being shared among these EHR users regionally, including customers of the same EHR vendors, and through statewide health information exchanges, according to the report. These success stories should provide “best practice models we can look to where data and information is flowing,” ONC National Coordinator Dr. Karen DeSalvo said in an interview. “What we don't see yet is a complete coalescing around the rules of the road” for a nationwide exchange network, she said.

“The plan's got the right bones,” said Devin Jopp, CEO of the Workgroup for Electronic Data Interchange. “It's all going to come down to execution. How do we coalesce around this stuff?” Still, he questioned the viability of the ONC's timetable, which he called “inspirational,” adding that “I'm not sure we can get to a learning health system in even 10 years.”

The ONC roadmap marks a turning point for the agency, which has been preoccupied with promoting the purchase and use of EHRs by providers. Interoperability of those systems up until now has held a lower priority. But the ONC has come under increasing pressure from Congress and healthcare provider groups to bear down on interoperability, which is essential for value-based payment and population health-based delivery models such as accountable care organizations.

Last week, HHS Secretary Sylvia Mathews Burwell announced that the CMS wants 50% of Medicare payments to be linked to these payment reform models by 2018, and a coalition of providers, insurers and employers separately pledged to have 75% of their members' business switched to performance-based contracts by 2020.

Payment reform is driving the change in ONC's policy focus, said Jennifer Covich Bordenick, CEO of the eHealth Initiative, a Washington-based promoter of health information technology. “The demand to move to these new payment models is tremendous, and the only way we're going to get there is to have access to the data,” she said. The overall tone of the ONC plan, which calls for a public/private partnership to create a “non-governmental governance” process for the proposed national health information network, “is very positive,” she said.

The ONC roadmap also calls for government and private-sector players to offer additional incentives for interoperability beyond those in the EHR incentive-payment program. The report also recognizes a need to better educate providers and their health information exchange partners on federal privacy and security rules, which the report says should enable data sharing rather than inhibit it, as is often the case now.

“This is a much-needed playbook for each and every health IT professional,” said Russell Branzell, CEO of the College of Healthcare Information Management Executives. The report offers healthcare providers and health IT developers a process for aligning clinical standards and improving interoperability, efficiency and patient safety, he said.

But Dr. Joseph Smith, chief medical and chief science officer for West Health, a San Diego-based health IT research group, said there's a vital element missing from the ONC plan.

The plan addresses information exchanged between computerized medical devices and EHRs, but does not interoperability between one device and another, which would benefit patients, he said.

“We need to make sure we leave no information source behind,” Smith said.

Follow Joseph Conn on Twitter: @MHJConn