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Coordinating Conversations about Healthcare Interoperability

By Kyle Murphy, PhD

- With or without federal pressure, healthcare interoperability is in need of advancement and that advancement will take place to serve the business needs of healthcare providers.

The ONC interoperability roadmap is helping drive conversations about how to achieve healthcare interoperability.

That was one important takeaway from a sit-down with two members of the Office of the National Coordinator for Health Information Technology during HIMSS15 about federal agency's role in advancing interoperability in healthcare — Interoperability Portfolio Manager Erica Galvez and the Director of the Office of Standards and Technology Steven Posnack.

"As delivery system reform advances, there is a push for this whether ONC says to do it or not," Galvez told HealthITInteroperability.com. "There will be solutions that evolve in the private sector because it makes business sense for technology developers and their customers."

That is not to say that ONC will not have an influence on the course healthcare interoperability will take in the years to come. Its shared nationwide interoperability roadmap makes clear the federal agency's intentions to help guide the way. "We hope that it will help frame holistically the broad big picture," added Posnack.

ONC currently finds itself in the process of working through industry feedback on its ten-year plan for enabling interoperable health IT, which has revealed widespread support for interoperability as well as differing opinions on how the proper way to achieve it.

"There is a constant back-and-forth that has to occur in order to make sure that we stay in lockstep with the course that we have plotted through the roadmap," Galvez relayed. "It is interesting to see that people want everything to happen now, but when we start to say what has to happen in order to make that real they say wait."

Erica Galvez serves as ONC Interoperability Portfolio Manager.In between publishing a vision paper and the first draft of the interoperability roadmap, ONC was already receiving calls to modify its approach.

"When we put out the vision paper before the roadmap, we were criticized for putting a ten-year timeline on it. And then when we plotted out what needs to happen in order to hit those visions we put at different points in time, people started to say it looked really aggressive," Galvez added.

The roadmap, however, is a work in progress and will undergo changes in line with the industry's needs. At present, Posnack credits the ONC plan with giving stakeholders the lay of the land.

"Often when we meet with stakeholders, we ask two broad questions — what can we do to help and what can we do to get out of the way?" he explained. "That's where the roadmap is going to be really important in terms of giving everyone at least a look at what the board looks like and everyone's pieces are and where we're each contributing in different directions."

All in all, ONC is pleased with the feedback is receiving, much of which confirms that its aims are in line with needs of both the developer and provider communities.

"Folks like the idea of having a roadmap," Galvez maintained. "They think interoperability is important. They want tweaks around the edges. There are specific sections where they think there needs to be more detail or we should think about a slightly different strategy."

Moving the conversation forward

Paving the way toward a learning (i.e., interoperable) health system has always been part of the mission of ONC, but to reach this point a few other pieces needed to be put in place — that is, the health IT infrastructure necessary for capturing and exchanging health data.

Steven Posnack serves as ONC Director of the Office of Standards and Technology."If we were having this conversation five or six years ago, we would be talking about adoption, 10 or 12 percent adoption rates, and how we are going to get providers to adopt electronic health record technology," Posnack explained. "Now we're at that point where everyone has something — they may not be 100 percent pleased with the technology that they have in some cases."

EHR and now health IT certification criteria play an important role in pushing the conversation about interoperability forward. ONC has kept a close eye on how health IT standards have impacted the healthcare industry. One such impact is in how the provider side now talks about health data exchange in the form of summary of care record exchange.

"At least from a provider awareness standpoint, they probably know c32," said Posnack. "What would be interesting is whether they know they are actually exchanging a CCD-A rather than a c32. That is the terminology distinction. They know they are exchanging a summary of care record electronically now but not necessarily which standard, version, or kind."

The federal agency is shifting its focus slightly to now take a closer look at how the selection and implementation of health IT standards is playing out in the field. "That is one of the things we need to track as a whole. As an industry, we need to find better ways to track how standards are being implemented and used in the field," Posnack admitted.

Part of moving the conversation about healthcare interoperability forward is taking place within ONC itself with those charged with health IT certification and interoperability having to work together more closely.

"It really is a braided relationship that we have," Galvez revealed. "The roadmap is a shared roadmap for the nation. It is also a roadmap for ONC. There specific things in each section of the roadmap that ONC commits to and a good chunk of those are within Steve's domain. So part of our jobs is to coordinate our overarching strategy, our overarching vision, and here are the pieces within his shop that need to evolve a certain way. He leads that and figures out that detail."

The same holds true from Posnack's perspective, especially as his office sets out to measure the federal agency's progress in the field over the next few years in meeting its self-imposed milestones. "That's more work I see us doing as well, which is part and parcel with some of the bigger, broader, grander vision policy-making work that Erica leads," added Posnack.

ONC and the healthcare industry have a long way to go to make interoperability a cornerstone of a learning health system, but they are already engaged in productive conversations aimed at determining how that vision is effectively realized.

Stay tuned for more insight from our interview with ONC's Galvez and Posnack.

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