The federal health information technology coordinator released a wide-ranging report Friday morning on how to improve interoperability in electronic health-record systems.
The report, “Connecting Health and Care for the Nation, A Shared Nationwide Interoperability Roadmap,” (PDF) calls for most 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.”
The common data set consists of about 20 basic elements, such as patient demographics, lab test results and identifiers for a patient's care team members. The plan is open for public comment through April 3.
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 to facilitate health data information exchange. The ONC intends to keep the list updated periodically.
Some health information is being exchanged among these EHR users, in regions, and among 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,” said Dr. Karen DeSalvo, coordinator of HHS' Office of the National Coordinator for Health IT.
But the agency also has heard from both insurers and providers that the level of health information exchange is insufficient for their needs, she said. Healthcare organizations wanting to exchange information have been hampered by a lack of consensus on which information exchange standards to use, how to configure computer systems to use them, and which rules and business practices to follow.
“What we don't see yet is a complete coalescing around the rules of the road” for a nationwide exchange network, DeSalvo said.
The ONC's interoperability roadmap calls for a public-private partnership to create a “governance framework” for health information exchange. It also calls for more work to be done developing and harmonizing interoperability standards “that will allow us to facilitate the sharing without a whole lot of extra effort,” she said.
The plan also calls for both government and private sector players to provide additional incentives for interoperability – beyond those in the EHR incentive payment program. And it sees 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.
The 2009 economic stimulus legislation that created the EHR incentive payment program, specifically ordered the ONC to “establish a governance mechanism for the nationwide health information network.” Since then, the agency has been under increasing criticism from members of Congress and professional groups about the lack of interoperability of EHRs despite the substantial public investment in them.
Improving interoperability of health information is a critical prerequisite for providers seeking to create patient-centered medical homes, population-based care management systems and accountable care organizations as both government and private sector payment reforms shift from fee-for-service to performance-based payment models.
On Monday, HHS Secretary Sylvia Mathews Burwell announced that by 2016 the CMS wants 30% of Medicare payments to be linked to these payment reform models, and 50% by 2018.
Wednesday, a coalition of providers, insurers and employers pledged to have 75% of their members' business switched to performance-based contracts by 2020.
In 2013, six Republican senators chastised the ONC for multiple health IT program failings, including a “lack of a clear path toward interoperability.” That month, the ONC issued a formal “request for information,” about possible governance models for health information exchange, a move that was viewed fearfully by some healthcare IT players as a possible first step toward federal regulation of health information exchange.
The ONC backed off in September in the face of industry pleadings to allow interoperability to develop, unregulated, through market-based approaches.
Earlier this month, in a letter to DeSalvo, the American Medical Association and nearly three dozen other medical societies and associations took the ONC to task on its health IT program problems, including a lack of interoperability.
“Ensuring electronic health information follows patients during transitions of care is one of the most sought after, yet the least successful exchange paradigms in health care today,” the AMA letter said.
DeSalvo insists the ONC roadmap isn't an attempt by the agency to become a national network regulator. A heading on a section of the roadmap refers to “non-governmental governance.”
“We are not specifically calling for a new entity for nationwide governance,” DeSalvo said, but, “We still want to give guidance and a timeline” for meeting plan objectives.
Veteran physician informaticist Dr. William Bria applauded the inclusion of priority use cases targeting electronic sharing of patient data with public health authorities and enabling patients to access to their own healthcare information, particularly on mobile devices.
“It strikes me that it's way past time to give the American public access to their own information and in a way they can actually use (it),” said Bria, president of the Association of Medical Directors of Information Systems. “They are the key customer that's really been left. It's overdue.”
View the first release of the Health IT Roadmap here.