Wednesday, October 15, 2014

The October Joint Meeting of the Standards and Policy Committee

Today the future of interoperability was discussed and endorsed by a joint meeting of the Standards and Policy Committees.

We began with a preamble clearly stating that the roadmap we’re working on is a process not a finished product.

Karen DeSalvo, Jacob Reider, Paul Tang and I offered framing comments for the day.

I suggested that Health IT is in its “trough of disillusionment” moment before it moves toward the “slope of enlightenment”.  In the past two weeks, many of my incoming emails have been punctuated with negative feelings about EHRs - Ebola caused by a lack of interoperability, physician/patient relationships strained by the distraction of new electronic workflow requirements, and poor usability.  The work ahead is to focus on interoperability, building on the lessons learned and progress made to address key workflow issues.

Erica Galvez from ONC provided initial interoperability framing, illustrating the progress we’ve made thus far.

It’s clear that millions of transactions are being exchanged today, addressing many use cases including public health, quality measurement, and transitions of care.

Erica then continued with the draft 10 year shared interoperability roadmap.

Key milestones included

2017 - providers and individuals send, receive, find, use a basic set of essential health information

2020 - granular information access, expanded uses of information.

2024 - learning healthcare system

This effort will be based on a foundation of standards, certification, security, culture change, and governance.

We broadly discussed the presentation.  Commenters described the tension between functional requirements and overly prescriptive standards, the need for innovation and the desire for adoption of mature standards, and the need for privacy and while at the same time fostering increased sharing.

In the afternoon we discussed governance, recognizing that both top down and bottom up models have their supporters.   Additional work will be down by the Policy Committee’s HIE Workgroup.

The capstone of the day was a presentation by the Jason Task Force, reviewing the Jason Report.

The six key points  from that presentation were:

*Focus on Interoperability. ONC and CMS should focus their efforts on interoperability, realizing that healthcare IT stakeholders cannot accomplish every goal simultaneously given limited time and resources
*Industry-Based Ecosystem. A Coordinated Architecture based on market-based arrangements should be defined to create an ecosystem to support interoperability .
*Data Sharing Networks in a Coordinated Architecture. The architecture should be based on a Coordinated Architecture that loosely couples market-based Data Sharing Networks (which might also be called Data Sharing Arrangements)
*Public Application Programming Interfaces (APIs) as a basic conduit of interoperability. The Public API should enable data- and document-level access to clinical and financial systems according to contemporary internet principles.
*Priority API Services. Core Data Services and Profiles should define the minimal data and document types supported by Public APIs.
*Government as market motivator. ONC should assertively monitor the progress of exchange and implement non-regulatory steps to catalyze the adoption of Public APIs.

The group discussed the challenge of focusing on interoperability while also pursing the prescriptive goals of meaningful use.   One commenter proposed examining the collective burden/impact of all ONC/CMS requirements and then deciding on phasing.

The group approved these 6 points by consensus as part of a transmittal letter from the federal advisory committees to ONC.

The key takeaway - the approval of these 6 points begins the movement away from a model in which data is extracted from an EHR and then pushed from point to point.   Instead the future belongs to real time query of document-based and discrete data from the point of origin where it is stored, to the point of use, such as another EHR, patient mobile device, or population health registry.  Standards that are generally used on the internet such as JSON, OAuth, and REST are likely candidates, especially as implemented in FHIR (Fast Healthcare Interoperability Resources).

The next step at the government level is joint federal advisory committee/ONC work over the next 90 days to finalize the roadmap combined with private sector work (industry, standards organizations, academia, patients, providers, payers) to accelerate standards that support the 6 points in Jason Task Force report.

A remarkable day with great energy and enthusiasm to move healthcare toward the same interoperability approach used by Facebook, Amazon, Google,  Apple App Store, and most non-healthcare industries.  2015 will be a pivotal year for real time query-based data exchange.

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