Of Thoreau and Thoughtful Standards: Building Foundations for Interoperability’s Worthy “Castles in the Air”

Feb. 4, 2015
The Jan. 30 release of the interoperability roadmap from the Office of the National Coordinator for Health IT, followed by statements made by ONC leaders at the agency’s annual meeting on Feb. 2, have cheered U.S. provider leaders

Monday’s developments at the Office of the National Coordinator for Health IT (ONC) sound positive indeed. At the ONC’s annual meeting, held in Washington, D.C., offered significant promise for providers anxious to see progress at ONC on a number of fronts.

As our Associate and Senior Contributing Editors Rajiv Leventhal and David Raths reported on Tuesday, at the meeting, “Karen DeSalvo, M.D., National Coordinator for Health IT, opened the day by saying that the government has listened to the health IT community's suggestions on how to make technology work for better health, and they are ready to ‘execute those actions.’ She mentioned President Obama’s recent commitment to interoperability as well, finally urging the audience to give their thoughts on the first draft of the roadmap, with public comments due on April 3. ‘If we do it right, we build a pathway to get to a place where we have a learning health system,’ DeSalvo said.”

Further, our editors reported, “Regarding the need for greater interoperability in healthcare, Erica Galvez, interoperability and exchange portfolio manager, ONC, noted via Skype (due to inclement weather) that the typical Medicare beneficiary receives care from two primary care providers and five specialists each year, signaling a huge opportunity for care coordination.,” adding that “In the near term… providers should be able to send, receive, find, and use a common set of clinical information. ‘Health data needs to flow in the delivery system, but also outside the system, and that is what I see as key to the roadmap,’ Galvez said. In terms of measuring success, she said it will be ‘based on the data sources that we have currently and measures we’re able to track currently. We put this framework in the roadmap, and we want comments on it.’”

The Feb. 2 meeting, warmly welcomed by provider leaders, followed the release on Jan. 30 of ONC’s interoperability roadmap. As Senior Editor Gabriel Perna reported on Jan. 30, “The ONC says that achieving the interoperable ecosystem will require work in three areas: 1) Standards 2) Motivating the use of those standards through incentives and 3) Creating a trusted environment for collecting, sharing, and using electronic health information. This trusted environment, the ONC says, will mean that different stakeholders will have to be aligned.”

What’s more, Karen DeSalvo, M.D., National Coordinator for Health IT, said in a statement about the release of the roadmap on Jan. 30, “To realize better care and the vision of a learning health system, we will work together across the public and private sectors to clearly define standards, motivate their use through clear incentives, and establish trust in the health IT ecosystem through defining the rules of engagement.  We look forward to working collaboratively and systematically with federal, state and private sector partners to see that electronic health information is available when and where it matters.”

Provider association leaders were quick to praise all the new developments coming out of ONC. On Jan. 30, shortly after the announcement of the release of the interoperability roadmap, leaders at the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME) released a statement that included the following: “The College of Healthcare Information Management Executives (CHIME) welcomed the release of ONC’s 2015 Interoperability Standards Advisory today as part of the Office’s broader Interoperability Roadmap. The Interoperability Standards Advisory is a non-binding, non-regulatory document meant to help facilitate discussion and debate on clinical standards currently used in healthcare and referenced in regulation. The Advisory identifies specific standards and references implementation guidelines across four areas of standards, including content, vocabulary, transport and services.”

CHIME’s statement included the following from president and CEO Russell P. Branzell: “This is a much-needed playbook for each and every health IT professional. Now,” Branzell said, “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. 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.”

The CHIME statement further added that “CHIME has long-advocated for clear, enforceable standards to help drive EHR optimization and interoperability. Last year, CHIME told policymakers that, ‘efforts to coalesce around transport, vocabulary and content standards – through ONC’s certification program and driven by meaningful use requirements – has been important work,’ but that there was a need to develop an ‘adaptable process’ for identifying standards.”

In other words, it’s past due the moment in U.S. healthcare to put some meat on the bones of true standards development for authentic interoperability, at a crucial moment in the industry, when the achievement of a lot of the health information exchange, accountable care, population health, and value-based purchasing and delivery goals of healthcare policymakers and industry leaders will rely incredibly strongly on clean, useful standards, delivered in an effective, transparent, and timely way.

One of the most hopeful aspects of all this is the realistic approach to all this in the near and medium term. As our Gabriel Perna reported on Jan. 30, “While the roadmap has the long-term goal of a complete interoperable system in 10 years, there is a three-year plan to enable a majority of individuals and providers across the care continuum to send, receive, find and use a common set of electronic clinical information at the nationwide level. The longer term goals are about standards for community-based services, social services, public health and the research community. In the nearer-term,” he added, “ONC will identify the best available technical standards for core interoperability functions that exist today. In conjunction with the roadmap, the ONC released the Draft 2015 Interoperability Advisory, which includes the best available standards and implementation specifications for interoperability of clinical health information.”

One thinks a bit of the classic quotation from American philosopher and author Henry David Thoreau: “If you have built castles in the air, your work need not be lost; that is where they should be. Now put the foundations under them.” Interoperability is an incredibly worthy castles-in-the-air vision for U.S. healthcare; and these new developments at ONC speak to the foundation-building that will be required to safely ground those castles in the future.

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