The Nationwide Interoperability Plan

The Nationwide Interoperability Plan

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In our previous articles about interoperability, you may remember the 10-year vision plan which the Office of the National Coordinator for Health Information Technology (ONC) laid out in 2014. In October 2015, after soliciting public feedback, the ONC finally unveiled the first draft of the Nationwide Interoperability Roadmap, with the help of a federal, state and private advisory committee. This living and evolving document serves as the plan for nationwide healthcare interoperability needed to build a “Learning Health System.” This integrated health care system would:

  • Enable value-based rather than cost-based payment for healthcare services, helping to eventually lower healthcare costs
  • Support real-time and aggregated case reporting, disease management, surveillance and research
  • Provide timely, actionable health data for more informed health decisions
  • Serve the learning needs of all participants and improve public health

Over the past few years, health care organizations have increased their adoption of electronic health record (EHR) technology and have begun connecting to regional and statewide healthcare information exchanges (HIEs). Some healthcare settings, such as ambulatory care and long-term-care, remain behind the large hospital systems and other early adopters. Overall, the number of organizations using healthcare IT and accessing patient data electronically has increased. In order for the vision of the interoperability roadmap to come to fruition, all stakeholders must commit to collaborating and advancing the goal of real-time data access, as well as to develop the interoperability standards to increase connectivity and information sharing.

Convergence and Connections:

In recent months, we have seen an emergence of public and private sectors working together, along with vendors and healthcare providers, to advance the vision of nationwide interoperability. For example, a public-private collaborative called Carequality, with representatives from private health systems, industry and government, has developed a framework of interoperability to enable cross-platform data sharing between vendors, providers and payers. Carequality is part of a larger group called the Sequoia Project that is working toward greater healthcare interoperability, but other groups also exist with similar goals, and these industry leaders continue to pave the way for nationwide interoperability.

Healthcare IT vendors have also begun to work together by forming information exchange alliance networks. CommonWell Health Alliance – a nonprofit trade association with the slogan “Health Alliance Interoperability for the Common Good – offers a platform for its service provider members to leverage existing standards and policies to improve the interoperability of health data exchange. Founding members include Athenahealth, Cerner and McKesson, and the group continues to add members, due to the growing appeal of the single platform and network. Organizations that adopt the interoperability framework can more easily share data and add partnerships, increasing their opportunity for overall connectivity.

A New Roadmap:

Based on the public feedback from the first draft of the Nationwide Interoperability Roadmap, the ONC has finalized a timeline for achieving its goals, which includes main drivers of the path, policy and technical components and eventual outcomes. Here is a quick overview of the timeline and goals, according to the ONC:

  • 2015-17: Send, receive, find and use priority data domains to improve healthcare quality and outcomes
  • 2018-20: Expand data sources and users in the interoperable health IT ecosystem to improve health and lower costs
  • 2020–24: Achieve nationwide interoperability to enable a learning health system

Within the roadmap version 1.0, some of the detailed requirements that must be met to achieve interoperability include the following:

  • A payment and regulatory environment focused on paying for quality versus quantity, with proper financial incentives to encourage the exchange of electronic health information.
  • Shared accountability and leadership from a diverse set of stakeholders to help create, expand and uphold the interoperability standards.
  • A secure and available network infrastructure that organizations can trust to prevent intrusions and cyber-attacks among large and small providers, along with security protocol to support it.
  • Identity verification, authentication and representation for all participants who exchange electronic health information, with compatibility and controls, as well as intuitive features for users.
  • Consistent permission rules for collection and distribution of electronic health information, including with whom and for what purposes, so patients have a clear indication of how their information will be used and shared.
  • Industry-wide testing and certification tools and resources developed specifically to enhance interoperability between platforms.
  • Standardized vocabulary/terminology and data semantics, as well as standards for content, format, transport, security and services so applications and interfaces can integrate more effectively and data can add more value in the new learning health system.
  • Prioritized needs and work toward interoperability, with a collaborative, transparent environment among stakeholders.
  • Consistent, secure transport techniques that are non-proprietary, easy to configure and widely and consistently used.
  • Individual empowerment for the access of health information to support individual and family engagement in health management.
  • Provider workflows that encourage interoperability, with the tools health care systems need to support information sharing.

A Vision of Future Interoperability:

All stakeholders – from healthcare service organizations to technology providers and state and local leadership -- must heed the calls to action and do their part in contributing to the nationwide interoperability plan. From enhancing our capability to exchange with one another, to increasing the volume and availability of exchanged information, providers can finally begin to use health data to make better decisions and improve outcomes. And with a feedback loop in place, stakeholders can continue to refine systems and processes to further improve interoperability.

History has shown that when vendors, providers and even regions develop systems independently, they can encounter problems when trying to integrate. At CoreTech, we can help our clients get on the path toward interoperability by starting small and navigating through each integration challenge individually, with a goal of becoming fully interoperable with other technologies, partners and processes.

Through a combined effort and commitment, the nation will continue to strive to attain a true learning health system, and can then enjoy the benefits of lower costs, better health and improved processes.