Tripathi on JASON; keeping policy on pace with technology

A lighter touch with respect to Meaningful Use (MU) Stage 3 requirements will help improve interoperability, according to a draft report by the JASON task force, which is tasked with crafting a final report based on the advisory committee’s recommendations.

The JASON task force, co-chaired by Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, and David McCallie, senior vice president of medical informatics at Cerner, already has found that MU Stages 1 and 2 have not advanced interoperability "in any practical sense."

That is due to the lack of a comprehensive nationwide architecture for health information exchange, ingrained EHR technology and business practices and the lack of incentives for data sharing.

Toward that end, the JASON report calls for redoubled efforts toward a unified interoperability architecture, to move data from legacy IT systems to "a new centrally orchestrated architecture to better serve clinical care, research and patient uses." This architecture would be based on the use of public application programming interfaces (APIs) for access to clinical documents and discrete data from EHRs, according to the report.

The Office of the National Coordinator for Health IT (ONC), according to the report, should "take immediate actions to motivate a public-private vision and roadmap" for a nationwide architecture for data exchange. That would then, hopefully, lead market forces toward the development of data sharing networks that would deploy public APIs that would expose core data services and core data profiles.

“To allow vendors and providers to focus their efforts on interoperability, [the Centers for Medicare & Medicaid Services (CMS)] and ONC should narrow the scope of MU Stage 3 and associated certification to focus on interoperability in return for higher requirements for interoperability," the report reads.

That goes against the current path, in which Stage 2 and the prescriptive 2014 edition certification criteria have "demonstrated that there is a trade-off between the complexity of requirements and the ability of most vendors and providers to stay with MU timelines. Reducing the breadth of MU requirements to focus on use cases demanding interoperability will free up provider and vendor resources to implement and adopt public APIs."

The JASON task force recommends a coordinated architecture "defined to meet the nation’s current and future interoperability needs, rather than an architecture defined and controlled from the top-down." That coordinated architecture should be based on a public API, which would "enable data- and document-level access to EHR-based information in accordance with modern interoperability design principles and patterns." The public API should "implement a set of rigorously defined core data services, which should be selected to expose key data access functions for high value healthcare interoperability use cases."

The coordinated architecture uses of the public API should support data sharing networks "that promote EHR-to-EHR interchange, and consumer access to the core data services via patient portals."

Meanwhile, the group said CMS and ONC should leverage Stage 3 to motivate private sector development of a coordinated architecture based on public APIs and focused on provider and consumer use cases. And, ONC should "aggressively monitor the progress of exchange across data sharing networks and consider an incremental range of interventions to accelerate cross-DSN exchange if the market does not enable such exchange on its own.

The creation of a JASON task force to formally look at the report and how much of it is feasible indicates the impact of the report, says Tripathi, who spoke with Clinical Innovation + Technology after the meeting.

The task force has had several meetings already and on Oct. 15, will present its final recommendations. “The prominence given to our output suggests that [ONC] is going to take our recommendations seriously and act upon them.”

As already noted by the task force, the timing of the JASON report adds challenges because the analysis conducted predated the start of MU Stage 2 as well as the Pioneer Accountable Care Organization and Medicare Shared Savings Programs. These developments have changed the demand for interoperability in the market, Tripathi said.

The biggest change is not in information exchange capabilities but “more about the trajectory.” Tripathi attributes some of the demand to Meaningful Use but also to accountable care.

These rapid changes does mean technology “is moving way faster than policy. That’s true in every aspect of our lives. We’re really focused on recognizing that it’s not just a technical issue but sort of a whole constellation of other issues. Business, policy, legal, culture all come into play. The JASON report is only focused on the software engineering part of it.”

Even while there are all these rapid changes, “we can’t just assume that overnight we can snap our fingers and everyone will have this new API and expect that’s going to allow data to flow fluidly and everyone is abiding by all the laws and rules and conventions. It’s really complex and there are a lot of interdependencies.”

Tripathi said it is very important for the healthcare industry to deploy the task force’s recommended public APIs because that is the way information exchange occurs in every other part of our economy. “Healthcare shouldn’t be any different. We need an overlay of privacy protections and appropriate use data protections that make it more complex than, say, Amazon.”

Healthcare can make information exchange progress best by “sharply narrowing the focus,” he says. Just the use of public APIs would “allow a developer to develop an interface to a public API to allow access to doctors or data elements like lab results or particular medications or allergies.” Rules are required to ensure that users are authenticated, they are authorized to access the data and they will understand data received so they are used appropriately.   

“Narrowing the focus--that’s, we believe, the pathway out of this,” says Tripathi. Use cases of the public API include allowing patients to sign up for apps through their existing patient portal. The app can then query databases in which patients already are established. “We can leverage that access and give patients another way to access their data.”

By focusing on these types of functions in Stage 3, Tripathi says “we can really boil down the policy issues and constrain as many as possible to make it doable. As we expand incrementally, we can hopefully develop policies about reasonable and well understood conventions around this to keep pace with the incremental expansion of information available through APIs.”