The federal government has released its final vision on how to achieve widespread interoperability of electronic health-record systems.
The Office of the National Coordinator for Health Information Technology on Tuesday released Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap, which is a revision of a draft released in January that called for providers to be able to send and receive electronic clinical information nationwide by the end of 2017.
The updated plan includes recommendations from public comment and industry experts, but, “the road map should be familiar to many who have been involved” thus far, ONC chief Dr. Karen DeSalvo said at a news briefing.
The road map outlines three broad components to achieving interoperability—an alignment of incentives, the necessary technical standards and implementation specifications, and the appropriate governance structures, DeSalvo said.
“We know we need to have the right business cases, or economic incentives,” to promote both the “push” and the “pull” of healthcare data, DeSalvo said. That is, in a nationwide system, providers must have the ability to both send, or push, data to another, and the ability to query other providers' EHRs or health information exchanges and retrieve, or pull, patient information from those systems, according to the ONC leader.
One specific, still-needed national standard DeSalvo mentioned was for accurately matching patients to their records.
And, DeSalvo said, there needs to be agreement on methods for privacy protection and cybersecurity.
“Data moves at the speed of trust and state lines can be an artificial barrier” to interoperability, DeSalvo said. But the ONC is not going to push for one national law pre-empting the various state approaches on healthcare privacy, DeSalvo said.
She said the ONC is once again working with the National Governors Association.
State protections for privacy are more stringent than those provided under the federal privacy law, the Health Insurance Portability and Accountability Act. But the state laws are not uniform.
Nearly a decade ago, the ONC studied differences in state privacy laws that posed barriers to interoperability, later, the agency issued a report that presented ways to address those barriers. Still, many remain.
Asked why working with the governors' association might be more effective today, DeSalvo said one reason is that states, which are relying more on managed-care approaches to their state-funded Medicaid programs, are now pressing for remedies to interoperability problems.
“State governments know they have to have a health IT infrastructure that supports data flow” as part of their Medicaid reforms, she said.
Jodi Daniel, outgoing director of the Office of Policy said, “Sometimes, timing is everything.”
In 2006, before the federal government began paying incentives to document and share records, far fewer healthcare providers had EHRs, so there was less data and less ability to exchange it.
“I think the time is right now,” Daniel said. “There is data. There is some flow of information. The fact that we tried before and made some progress, we have some place to build from.”
The road map won praise from two industry organizations.
"We support the roadmap's recommendations for broader, governmental action to promote consistent, national interoperability standards, including the use of open-source application programming interfaces to support the secure transfer of information between and among different HIT platforms," said Blair Childs, senior vice president of public affairs, Premier, one of the nation's largest group purchasing organizations.
"We commend ONC for emphasizing in the road map the role that patients and families play as partners in the continuum of care, and the need to engage them in electronic access to and use of health information. This is a welcome, powerful and badly needed new tool that can advance the kind of care consumers want and the nation needs," said Debra Ness, president of the National Partnership for Women & Families.
