- Industry feedback on the first draft of the nationwide interoperability roadmap published by the Office of the National Coordinator for Health Information Technology (ONC) has made its way to the federal agency which must now consider the concerns raised by its proposed plan. And while the feedback varies in terms of the particulars, many similarities are immediately present.
Both the American Hospital Association and American Medical Association perceive the roadmap to be too forward-looking in its scope, which could undermine the successful necessary activities to be completed in the near term.
"While the AHA agrees with ONC’s aspirations for the future," writes AHA Senior Vice President of Public Policy Analysis and Development Linda E. Fishman, "we are concerned that the roadmap is not sufficiently grounded in an assessment of present realities or focused enough on the steps that will enable public and private stakeholders to travel from the present regulatory, clinical and technology environment to the future state envisioned."
To further support the point, the AMA's comments on the ONC's plan for nationwide interoperability focus only on the goals that need to be met in the next two years.
"While the Roadmap extends out through 2024 we believe that the primary focus should be on the immediate needs of physicians and patients and to reassess other goals later on," the letter from AMA CEO and Executive Vice President James L. Madara, MD, states. "We have therefore constrained our comments to the years 2015-2017 of the Roadmap."
For the AHA, the top priority at the moment for interoperability is building a health IT infrastructure based on current EHR technology whose use the ONC and the Centers for Medicare & Medicaid Services has promoted through the EHR Incentive Programs.
"Given the significant investments already made, the AHA urges ONC to adopt the current requirements of the meaningful use program and the capabilities of the 2014 Edition certified EHRs as the starting point for the nationwide interoperability roadmap," Fishman maintains.
Similarly, the AMA is focusing on the need for interoperability between EHR technology and clinical registries in order to prove its value to healthcare organizations and providers.
"As physicians transition to value-based payment models, they will require technology and standards that enable data exchange and care coordination," Madara explains. "For this to happen, not only must there be a supportive business case to drive use and innovation, but also a solid infrastructure upon which to build meaningful information exchange."
Pushing for consensus
The College of Health Information Management Executives (CHIME), Association of Medical Directors of Information Systems (AMDIS), and Healthcare Information and Management Systems Society (HIMSS) have all emphasized the need for industry stakeholders to come together and agree on the direction healthcare interoperability must take in order to be achieved.
For the latter, it is a matter of governance that is shared rather than dependent on a single entity.
"No single network, organization, or process will be able to provide and manage the interoperability life cycle," writes HIMSS Board Chair Paul Kleeberg, MD, FAAFP, FHIMSS, and President & CEO H. Stephen Lieber, CAE. "We, therefore, do not foresee a unitary and monolithic governance process, rather a set of processes that requires some coordination, but largely can operate independently as long as the overall scope, focus, and direction is well understood and shared."
An example of where governance is needed for CHIME and AMDIS is around patient identification, which tops the two organizations' joint recommendations to the ONC:
A national approach to patient identification is prerequisite for interoperability and the lack of a standard patient identifier only serves to aggravate our industry’s technical challenges. Without a standard patient identifier, the creation of a longitudinal care record, composed of data created through disparate systems, geographies and chronology is simply not feasible. Future drafts of this roadmap must enable development of a standard patient identifier.
What's next for the ONC is to sift through the detailed recommendations for nationwide interoperability which are legion.