- Verbs used to describe work on interoperability (e.g., achieve, reach) give the impression that the task once done is complete. But the emergence of new technology and data sets with the potential to positively impact care delivery renders that impression myopic, according to ONC’s second-in-command.
“Interoperability is not something you solve and then you go home. Interoperability is a moving target,” Principal Deputy National Coordinator Genevieve Morris told EHRIntelligence.com. “Right now we’re working on making certain sets of data interoperable, but we still need to get to genomic data and all the things you need to do for precision medicine, which are totally different data sets.”
That is the kind of thinking behind the roadmap for healthcare interoperability the federal agency released in 2015, a document that continues to guide ONC's work in collaboration with both the private and public sector. In a learning health system — a totally integrated healthcare environment — interoperability takes on a new and expanded meaning beyond EHR-to-EHR connectivity, although the latter plays a foundational role.
“The definition of interoperability expands in a pragmatic, incremental fashion,” Morris explained. “Some of the underlying standards and technical pieces that you need to be able to do medical device integration and patient-generated health data are the same things we need for the interoperability we’re working on now.”
One example those technical pieces is provenance — knowing the individual or device that created a data element as well as when and where.
“We need that now for clinical data between EHRs,” Morris emphasized. “Providers want to know who that data came from for lots of reasons. If you’re looking at a patient’s medication list and you don’t understand why they were put on a particular medication, you’re not going to change that prescription without first talking to the physician who actually prescribed it. You can’t do that if there’s no provenance tag.”
While much of the national focus remains on EHR interoperability, the latter needs to serve as a means of addressing future healthcare interoperability challenges rather than proving a hindrance.
“Those standards we’re still honestly in process on, both developing and rolling out for that EHR-to-EHR to EHR-to-other health IT vendor, are the baseline underlying infrastructure necessary to get better medical device interoperability and all those other things that come in to play,” said Morris.
ONC as Collaborator
ONC has helped champion several efforts to advance healthcare interoperability in collaboration with industry, such as the patient matching algorithm challenge and support for the development of the FHIR API.
“We have tried our best to step in on some things like the patient matching algorithm challenge where we were trying to figure out how we get closer to narrowing that percentage of duplicates, which is one of the goals in the roadmap,” Morris noted. “We’ve seen a lot of progress around industry developing the FHIR API, which is one of the things we suggested in the roadmap.”
Its efforts in these two areas represent ONC’s view of itself as less regulatory and more facilitative.
“It’s been encouraging to see the industry to pick up a number of the calls to action we gave to them — because we can’t do it alone — and really start to run with it,” added Morris. “I’ve only been in this role for less than a year and I’m very aware of the hard work that the industry is doing. And I’m happy they are doing it — they should be doing it — and really happy with the progress we’ve made so far.”
The ONC deputy chief sees the forthcoming final rule on Trusted Exchange Framework and Common Agreement (TEFCA) as product borne out of collaboration and one that will keep the federal agency on its trajectory of reaching the goals it set two years ago.
But the federal agency and its partners can’t rest on their laurels just yet (if at all).
“As we get more interoperability we expect more interoperability,” Morris acknowledged. “I don’t think anyone would step back and say we’ve gone far enough, we’ve done enough. We want to build on what the industry is doing. We want to help the industry push forward into more interoperability to get at a lot of the use cases we’re still missing and get to the groups who frankly right now are a bit disenfranchised.”
The challenge for ONC will be to support the right causes and use its influence wisely and most effectively — to disrupt healthcare in beneficial ways.
“Disruption for disruption’s sake is not helpful. Disruption that helps move things forward and build on what we’ve done and extends it, that is helpful to the industry and that is what our goal is,” said Morris.
ONC remains hopeful that the federal agency is on the right track to a learning health system as a result of meaningfully advancing healthcare interoperability.
“We have to keep taking it step by step, figure out what the standards are and what those roadblocks to other types of interoperability happening, and tackle them as they come along,” Morris concluded.