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Task Force to Add Health IT Interoperability ‘Exemplars’

By Frank Irving

- The Health IT Policy Committee (HITPC)’s task force on addressing barriers to healthcare interoperability met on Oct. 9 to review the Shared Nationwide Interoperability Roadmap, which was released in final form last week by the Office of the National Coordinator for Health IT (ONC). The group discussed ways in which aspects of the Roadmap could be integrated into a final HITPC report due to Congress by the end of this year.

The HITPC task force on overcoming barriers to interoperability discussed ways to make its recommendations clearer and more actionable.

The task force, which has drafted out four major recommendations, now plans to include examples in those areas to add clarity and provide the basis for immediate action, according to chairman Paul Tang.

The four recommendations are:

1) Convene a major stakeholder initiative co-led by the federal government (e.g., ONC and CMS) and private sector to act on the ONC Roadmap to accelerate the pace of change toward interoperability.

2) Develop and implement meaningful measures of health information exchange (HIE)-sensitive outcomes for public reporting and payment.

3) Develop and implement HIE-sensitive performance measures for certification and public reporting.

4) Set HIE-sensitive payment initiatives — including performance measure criteria — and a timeline for implementation that establishes clear objectives regarding what must be accomplished under alternative payment models.

“We really want to translate the calls to action into an action plan, and the players that are required to reach the milestones,” explained Tang. “Our focus is on the things that need to be done now. I think we’ve captured some very critical tipping-point actions that could move us much more quickly and in a reconciled way toward this new goal.”

Task force member Christine Bechtel from the Bechtel Health Advisory Group agreed with the approach and the apparent alignment with ONC’s Roadmap, but called for more detail in the areas of privacy and security and the role of the patient. “It would be worthwhile as we move forward [to dig] into the Roadmap elements to see what we could lift up as additional recommendations,” she suggested.

“In my view, the role that consumers can play in supporting interoperability is an important lever that we haven’t done a good job of pulling,” Bechtel continued. “One of the things that could advance the market is if consumers are equipped to get their own health data — and if providers are actually equipped to receive it.”

Julia Adler-Milstein, a task force member from the University of Michigan, raised the possibility of adding a recommendation that would have immediate impact by requiring near-term action.

Tang noted that Recommendation 1 ideally would happen by the end of the first quarter of 2016, about the time when initial rulemaking on alternative payment models would be released by the Centers for Medicare and Medicaid Services. He added that although the HIE-sensitive measures referenced in Recommendations 2 and 3 will require some lead time, work on endorsed measures would need to start in the intermediate term. He also noted that the payment initiatives set forth in Recommendation 4 are also intended to be near-term objectives.

Larry Wolf, a task force member from Kindred Healthcare, pointed to a recent example from Intel’s private healthcare network, which now requires providers to participate in the Sequoia Project’s Healtheway interoperability initiative. “It’s a big tick up on using an existing infrastructure to provide real access to patient information. The payer said, ‘If you want our money, you have to be in this HIE,’” according to Wolf.

Wolf also referenced an upcoming white paper from Intermountain Health on how to improve data quality to be used for patient matching in a closed network. “It speaks to getting the details right,” Wolf commented. “In the end, there’s a lot of hard work that needs to be done just to clean up data and processes.”

Tang said the task force should consider adding such “exemplars” to its recommendations to make them clearer and to highlight candidates for immediate action.

Wolf remarked that the ONC Roadmap establishes a broad pathway forward, overcoming barriers in the process. However, the task force report needs to include explanation of “the things it takes to be successful, the key rallying points.”

The task force is aiming to finalize its report during an Oct. 23 meeting in preparation for presentation to HITPC on Nov. 10.

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