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ONC Chief Talks Health IT Standards, Information Sharing

The newest National Coordinator talks health IT standards, health data exchange, and the challenge of pushing healthcare interoperability forward.

By Kyle Murphy, PhD

- Nearly a year has passed since the Office of the National Coordinator for Health Information Technology (ONC) issued its ten-year roadmap for achieving nationwide healthcare interoperability.

National Coordinator Vindell Washington

Since that time, plenty has changed in and around health IT interoperability, such as the proposed replacement of various quality reporting programs with the Quality Payment Program and its provisions for the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) impacting eligible clinicians.

Specifically at ONC, the federal agency recently bid farewell to health IT interoperability champion Karen DeSalvo, MD, MPH, MSc, who left her post to focus full time on her position as Acting Assistant Secretary for Health in the Department of Health & Human Services.

Taking her place is Vindell Washington, MD, MHCM, FACEP, who recently participated in a media briefing to speak to and answer questions about the federal agency's role in and around health IT adoption and use.

While questions focused on a variety of topics, the agency's role relative to health IT standards and information exchange predominated the meeting.

READ MORE: Health IT Standard FHIR Ready to Advance Interoperability

What follows are National Coordinator Washington's comments on ONC's work in removing obstacles in the way of health data exchange and promoting the use of health IT standards such as Fast Healthcare Interoperability Resources (FHIR).

The department's role to promote advances in healthcare interoperability:

The ONC approach to interoperability focuses on three major areas. One is standards and using standards that are nationally-recognized as we point to standards that come up from the environment. The second one really is on payment changes and changing the way that care is paid for, and that work we're doing in conjunction with our partners at CMS. The third may actually be the most important — that is working toward cultural changes around the sharing of information. We're done most of our work in that space with the Office for Civil Rights, making sure that patients know that information should be there, that it should be exchanged and available when and where they need it for their care…We're focused particularly on those because those are the ones that are most likely to move the information sharing that we all desire for in the healthcare ecosystem.

ONC support for developing and using health IT standards:

As standards mature and as time goes along, we underscore and point to standards as they develop…The way to get there is through this public/private approach to interoperability. The standards advisory is the best example of that. And if you look at the standards advisory that was recently released, it's organization by use cases and often depends on what information is being passed, for what use it's being passed, what the standard should be. And you'll also see that there are areas of evolution in the standards advisory.

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As the government moves forward and as those standards mature, you have a move in that direction that underscores the specificity of standards that are necessary for passing information…You draw the lines in the road but you allow enough room for innovation across the sector so that you end up in the best possible place with standards.

The federal agency's view of interoperability initiatives such as Carequality and CommonWell:

As a general stance, ONC applauds the work in those sectors to move interoperability forward…Our general approach is to applaud the sharing of information that allows it to be available when and where patients need. We're also particularly focused in on that there is a level playing field, that folks are not left out. We have some what I would consider very encouraging evidence in the field of exchange that's working…The thing that strikes us, though, is that there is an opportunity to do more. It's how broad and how deep the exchange is that we're talking about. There remain what I would say opportunities across the ecosystem.

Top priorities for the federal agency heading into 2017:

I believe that the work we're doing on information sharing is actually foundational work for a number of the administration's priorities. It's about for delivery system reform. It's particularly important for the Precision Medicine Initiative and the Cancer Moonshot. And even though those are large and in some ways longer-term strategies, the work that we have to do in the short term is really around increasing this flow of information, empowering patients in this space to have their information and be able to use it and send it for the purposes that they choose. So the work that we're doing is in particular aimed in those areas.

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We're working with CMS as they come out with their final rules on MACRA from a payment perspective. We're working with OCR, as I mentioned several times before, around this concept of patient information and what should be available and clarifying the rules around HIPAA. There has been some resistant to information flow because folks don't understand the rules as much as they should — so getting that word out and pushing that forward in these last few months we think is particularly important. And in terms of standards, one of the ways you can push for standards is you can have concrete use cases...Standards will always be a whiteboard exercise until they are in wide and deep use.

The role that FHIR will play in the future of healthcare interoperability:

There are several demonstrations that are in use using FHIR APIs, and I would actually refer more to the work that came out of Argonaut and from folks who are doing it in the field to take the temperature on it. My impression from both reading that and having seen some of the demonstration pieces is that folks continue to believe that there is great promise in the FHIR API…Our goal from a standards perspective is to refer folks to the standards advisory and to work around that collaboratively.

Standards as I'm sure you're well aware do both mature and have adjustment with more and more widespread adoption. So my presumption is as you move and those vendors move from demonstration products and projects to more widespread work that there will be even more refinement that occurs. But based on their enthusiasm around privacy and security aspects and the ability to manage the information flow that they desire, we're pleased that that innovation is going on and we're watching their progress.

The National Coordinator's first meeting with the press came nearly a month after the federal agency released issued its annual interoperability standards advisory.

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