Electronic Health Records

Integration & Interoperability News

Clinical Engagement Needed for Healthcare Interoperability

By Kyle Murphy, PhD

- Healthcare providers can be either the beneficiaries or victims of health IT standards, yet providers often are left out of conversations about these standards when it comes to their development in the lab and implementation in the field.

Healthcare interoperability needs clinician engagement to advance

During HIMSS15, representatives from the Office of the National Coordinator for Health Information Technology (ONC) were actively engaged in conversations about advancing healthcare interoperability.

In an article yesterday, ONC Interoperability Portfolio Manager Erica Galvez and the Director of the Office of Standards and Technology Steven Posnack touched on the importance of increasing the healthcare industry's awareness of the many factors necessary for establishing an nationwide interoperable health IT infrastructure.

Although interoperability begins with health IT standards and their implementation, ONC sees the challenge as one that is primarily non-technical.

"Making the technology work is one really important piece. If the technology isn't capable technically of interoperating, then we have a foundational problem. Actually what we're finding is a little bit of an issue around implementation of technical standards," Galvez told HealthITInteorperability.com.

"There is a big issue around the policy wrapper and the environmental factors that circulate around that technology piece that have a huge impact on interoperability and the movement of information and it has nothing to do with technology and standards," she continued. "It has to do with establishing trust, business practices, disparate laws that govern how information is moved and when and where it can be shared. This is part of why you see such a long roadmap."

According to her colleague, the policy wrapper imposes a host of requirements on the form the  consolidated continuity of care architecture (C-CDA) might ultimately assume and conflict with the needs of clinical end-users.

"If there is a certain regulatory program or state policy that certain information needs to go, that may not necessarily be in alignment with what providers expect to receive from their colleagues," Posnack explained. " It is a short list of specific information at a minimum that they want to know. Maybe it's in there, but it's just buried somewhere."

Through its new proposed rule for health IT certification, ONC is planning to commit to the role of a true coordinator in convening not only standards development organizations (SDOs) and health IT developers but also clinicians and providers.

"One of the things as a coordinator we're looking to do more in the future as the roadmap milestones get set is to determine who needs to be involved to make this better," added Posnack.

The notion of clinician engagement becomes especially important as ONC works to expand health IT certification to account for providers not eligible for the EHR Incentive Programs whose health IT adoption will determine whether health data is able to move along the entire care continuum.

"When you look at the definition of health IT, it's pretty broad — it's not just EHRs," Posnack stressed. "The certified EHR technology construct is at least specific and part and parcel with the EHR Incentive Programs. But when we look at the broader reform activities that are ongoing and the care continuum and providers who are not part of the EHR Incentive Programs, we can do more to help and add value vis-à-vis certification if those stakeholders demand it."

Expanding health IT adoption to meaningful use non-eligibles is a driving force behind proposals for increased surveillance by ONC-authorized testing and certification organizations — to ensure that the implementation of health IT standards in these markets is consistent with its strategy for advancing healthcare interoperability. "All of these other policy pieces and environmental factors have to line up," said Galvez.

Aligning health IT standards, policies, and other factors with feedback from the clinical community should have the added benefit of improving health IT usability so long as providers make their demands heard.

 "The data is moving now. It is a second round of maturation around how it is displayed to users, how it's conveyed, the ways that they can manipulate and customize it to advance their own practice and thinking," added Posnack.

Clinical engagement isn't only necessary for successful health IT adoption. It also need to play a role in health IT standards development and implementation to ensure health IT usability.