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Talk of interoperability was everywhere during National Health IT Week last month, but it seems that it's still nowhere to be found.
When the Office of the National Coordinator for Health Information Technology (ONC) started its work more than a decade ago, the issue of interoperability was front and center. Stakeholders stressed the need for interoperable data and systems as a precursor to health IT fulfilling its potential of improving care and outcomes and reducing costs.
Yet, here we are in 2014, continuing our quest and debate around what interoperability should look like and how we get there.
When ONC Director Karen DeSalvo took the helm in early 2014, she pledged to make interoperability a pillar of her tenure and cited it as a foundation for allowing health information to follow the patient.
Earlier this year, ONC presented its 10-year vision for an interoperable health IT system with three, six and 10-year milestones. By 2017, the goal is for providers and individuals to have the ability to send, receive, find and use health information to improve health care quality and patient outcomes. The report cites examples, such as “Primary care providers share a basic set of patient information with specialists during referrals; specialists ‘close the information loop’ by sending updated basic information back to the primary care provider.”
The six-year milestone focuses on including a broader array of sources and individuals to help improve quality and drive down costs. The goal at 10 years is to realize the learning health system, in which individuals “manage information from their own electronic devices and share that information seamlessly across multiple electronic platforms as appropriate (health care providers, social service providers, consumer-facing apps and tools.)”
The next step is to build a roadmap. ONC will first preview areas of consensus in October and publish a first draft of the roadmap in January for further comment and feedback.
In some ways, we are a victim of our own success when it comes to interoperability progress. The health IT incentive programs, born out of the American Recovery and Reinvestment Act, made great strides in adoption. Today, more than one-half of office-based professionals and more than eight in 10 hospitals are meaningfully using electronic health records (EHRs). In addition, all 50 states have some type of health IT exchange services available to support care.
The enthusiasm for adoption – fueled by time-sensitive incentive programs –has, in some ways, caused the industry to get ahead of itself and focus on deployment at the expense of a foundational vendor-agnostic interoperability strategy. We’re still grappling with some of the fundamental questions of data standardization, privacy, and connectivity that have haunted us for decades.
Where do we go from here? First, the solution will require public and private cooperation across all stakeholders, including providers, government agencies, and vendors. Second, there must be clearly defined incentives to work together and perceived penalties for those that don’t. For example, new payment models that reward care coordination over care silos, and value over volume, must recognize health IT as a central unifying force, but only if health IT is interoperable. We expect new Alternative Payment Models in the next iteration of the Medicare Doc Fix to include such a concept for medical homes, ACOs, bundled and episodic payments, among other models. Third, let’s select a roadmap – quickly – and stick with it.
The building blocks set forth in ONC’s interoperability vision provide a solid stockpile of materials for constructing the path forward. They include: core technical standards; certification; privacy and security protections; supportive business, clinical and regulatory environments; and a clearly defined governance structure. Publishing interfaces and relying on open standards to promote innovation and competition will also help ensure providers are no longer locked into systems that don’t work for them.
We have made great strides in bringing eHealth to the citizens of the United States. Let’s all commit to digging in and building sustainable interoperability across the Health IT ecosystem so that the learning health system that is within our reach, becomes a reality.