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November 2014

The ONC's Idyllic Interoperability Idea
By Robert N. Mitchell
For The Record
Vol. 26 No. 11 P. 6

An interoperable HIT ecosystem makes the right data available to the right people at the right time across products and organizations in a way that can be used meaningfully by recipients, according to the report "Connecting Health and Care for the Nation: A Ten Year Vision to Achieve Interoperable Health IT Infrastructure," from the Office of the National Coordinator for Health Information Technology (ONC).

Is it a lofty and long-overdue goal? Perhaps.

Seeing that interoperability has been discussed for many years, why release a 10-year vision now? Is it attainable? Many knowledgeable industry observers say based on the current HIT and policy initiatives, the industry can achieve the plan's milestones.

The Vision
By 2024, the ONC says, individuals, providers, communities, and researchers should have interoperable HIT products and services that create a learning system that advances the goal of improving health for all. In 10 years, the nation's HIT infrastructure will support better care through improved connectivity that enhances individual health management. Advanced technologies will enable innovation and the broader use of health information to further support research and public health.

As standards, policies, and the data infrastructure evolve, the ONC's vision will allow for data collection that's more readily shared for the benefit of the individual and aggregated for population-based outcomes research. The report says that continuous learning and improvements will make it possible to analyze aggregated data and use them locally at the point of care to target specific clinical decision support.

What It Means
The ONC's 10-year plan is built on the following principles:
• build on the existing HIT infrastructure;
• one size doesn't fit all;
• empower individuals;
• leverage the market;
• simplify;
• maintain modularity;
• consider the current environment and support multiple levels of advancement;
• focus on value; and
• protect privacy and security in all aspects of interoperability.

Erica Galvez, the ONC's interoperability portfolio manager, says the 10-year vision is important because "it reaffirms our commitment to interoperability and takes the opportunity to invite others to work collectively toward achieving its goals.

"It also reaffirms the need for an ongoing dialogue about interoperability," she says. "Hopefully, many of the folks who will participate have already been involved and will further help us gain insight, as well as knowledge from new stakeholder participation. That's why we're calling for a new dialogue that reenergizes the interoperability discussions."

In addition to the vision paper, the ONC is leading the development of a companion roadmap that will identify "where things need to be, broadly, to achieve the vision we describe for three, six, and 10 years from now," Galvez says.

At three years, the goal is to send, receive, find, and use health information to improve health care quality. In six years, health care organizations should also be using health information to lower costs. The program culminates with the creation of the learning health system.

Aaron Seib, CEO of the National Association for Trusted Exchange, which joins state HIT programs to find common solutions for exchanging health information, says the ONC's vision establishes priorities and outlines what needs to be accomplished. "It doesn't put anything that's already been done out of place and establishes what's important for patient engagement that ensures people are actively engaged in their own care," he says. "It doesn't try to overdefine things. [The ONC] wants to get input from all stakeholders. It sets a roadmap and seeks public comment—they want to know what the burning issues are that you'd like them to address."

Seib notes the vision expands on earlier initiatives, such as the Direct Project, which developed specifications for creating a secure, scalable, and standards-based method of transporting encrypted health information over the Internet.

The Learning Health System
Galvez says the ONC's vision is based on creating a true learning health system. "This speaks to research, not just EHRs. It creates an environment of interoperable data sources and data users, where clinical information can be appropriately used for research that in turn generates new evidence and will, in fact, inform future delivery of care," she says. "[It establishes] a new ecosystem grounded in electronic information that moves data to a point where it's needed, can be aggregated, and used appropriately."

The vision incorporates various health care sectors. "The learning health system will bring findings from areas like comparative effectiveness research to care delivery, where evidenced-based information is then put together to benefit the consumer," Galvez says. "The lag time between research findings in academia and what's applied in practice will actually be shortened and information will flow for the right purposes to clinicians. The vision also emphasizes a focus on supporting health—with a broad focus on health care improvements and learning."

John Stanley, a vice president at Impact Advisors, an HIT consulting firm, says it would be incorrect to assume that the ONC's vision is limited to health information exchange. "It's not only information exchange—it's not just about technology. In the end, it's also about care management and changing the current trajectory of health care costs and quality," he says. "The market will have to continue to evolve on how we can be more effective with health information."

The report establishes goals, but doesn't tell health care organizations how to get there, which is a positive, according to Charles Jaffe, MD, PhD, CEO of Health Level Seven International (HL7). "The core of the 10-year vision is its guiding principles, which are sound and well reasoned," he says. "Success, or failure, will be predicated upon how we implement them. The details will matter."

The challenge is envisioning what technology will look like in five years, never mind 10. Because of the variability in a diverse and evolving system, Jaffe says establishing how to address standards is difficult. Over time, more requirements are added to system specifications, which increases cost and complexity. HL7's Fast Healthcare Interoperable Resources (FHIR) defines a new framework for extending and adapting existing solutions. "FHIR can enable more seamless interoperability using the existing architectures," he says. "FHIR also allows us to progress to interoperable solutions in a shorter time frame and at a lower cost. Ultimately, this leads to higher quality of care as well as to clinical safety."

Key Component
In the end, it is health care consumers who are at the center of the ONC's 10-year vision. Patients, and those who assist in their care (provider, family, and others), will need information to be readily available. "The consumer is an essential component because health is as much about what happens outside of the provider's office as what happens in it," Galvez says. "Thinking about an interoperable health IT ecosystem, it's about the person receiving the right care at the right time, with the right provider who has the correct information. It's about health and wellness, whether the person is healthy or sick, and the consumer is fundamental to all of these discussions."

— Robert N. Mitchell is a freelance writer based in King of Prussia, Pennsylvania.