HITPC considers more interoperability roadmap recommendations

In the ongoing effort to develop an interoperability roadmap, the Interoperability and Health Information Exchange Work Group presented draft recommendations and the thoughts behind them during the Nov. 4 Health IT Policy Committee meeting.

Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative and work group chair, reviewed the JASON Task Force and Governance subgroup materials to show how they could be incorporated into the interoperability roadmap.

The JASON Task Force recommended that the federal government focus on an escalating series of actions to catalyze market development of interoperability coordination structures and processes. “First and foremost, we want a set of recommendations that establishes government participation as engaged and vocal market participants, conducting active monitoring, convening, offering guidance and aligning incentive programs,” said Tripathi. The group said the government exerting direct authority to dictate terms of interoperability (requirements, monitoring, compliance, enforcement) should only be a last resort and only used to resolve gaps identified through active monitoring that the market seems unable to address on its own.

Tripathi outlined several key questions, such as are the goals meaningful to healthcare outcomes? Do they appear attainable by industry, which includes both users and vendors? “We’ve seen that we can only go so far so fast.” Are the goals well-defined enough to define organizational strategies? “We want to make sure the goals are something organizations could actually see meaning in.” Are the goals universal enough to be resilient to industry and technology change? “We’re probably, over the 10-year timeframe, probably going to have 2-3 major technological changes we don’t know about yet.”

Tripathi said the goals also must be measurable and not tied to a particular technology.

Each roadmap building block has draft milestones and actions, he explained. Again, the work group considered several key questions, such as whether the milestones are attainable, are the proposed actions aligned with milestones, are they appropriate to current and expected industry dynamics and focused enough to drive resource allocation and decision-making.

“The very first thing we should be doing is defining specific goals,” Tripathi said, “and monitoring mechanisms. Next is explicit endorsement of coordinated architecture based on public APIs as the nationwide technological architecture for interoperability to support a learning healthcare system. Third is establishing processes such as determining priority functions and associated minimum set of common interoperability standards.

The work group established three primary recommendations for operations governance. First, measure and monitor coordinated architecture development through data-sharing networks and use of public API deployment and use. Second, align federal agencies and incentive programs with public API deployment and use. Third, motivate market-based mechanisms for defining public API resources and profiles and associated legal/business/policy arrangements for research and consumer access use cases.

Tripathi wrapped up his presentation with four high-level thoughts:

• The interoperability roadmap needs to be more clear on what constitutes successful achievement of milestones. Are the milestones for vanguard innovators or for those bringing up the rear? Do they describe availability or adoption? “We may want to define expectations and predictions for the leading and lagging adopters,” he said.
• The time-phasing of the goals and milestones may be too conservative. The market is moving faster in many key areas, such as wearables and genomics.
• Coordinated architecture including core data service and the public API should be included as a key roadmap goal or milestone. “The roadmap focuses on high-level use cases and part of the roadmap ought to perhaps include something about the technical basis for how this happens recognizing that this evolves.”
• The federal government should initiate market motivator activities especially with regard to interoperability metrics and monitoring. “We think they shouldn’t wait for the roadmap. But calibrate governance activities to address observable and measurable gaps that the market fails to address on its own.”

National Coordinator Karen Desalvo, MD, MPH, MSc, said she wants to be sure the roadmap “is raising the floor but staying out of the way of innovation.” She also noted that there are still areas without internet access and she does not want to exacerbate the digital divide. She supported the concept of leaving room for changes in the market that are difficult to anticipate at this point.

“We have to be really thoughtful of the societal good of the data with respect to public health and advancing science. Remember that as we’re thinking of the foundation of governance, we want to make sure we’re considering potential use cases that might not have clear financial models at this point.”

Committee member David Lansky, PhD, president and CEO of the Pacific Business Group on Health, noted that market players “have to feel they’re getting value out of the infrastructure. Up to now, that generally hasn’t been the case.” The roadmap has to consider how the data architecture supports market action because “that, in turn, will drive the larger capabilities we want to see.”

Lansky also said he hopes the roadmap will help healthcare work toward metrics that ensure better care coordination and information at handoffs and measuring those outcomes over time. “Those are the outcomes that matter. They matter more than breaking down the processes and functional improvements we want to gain through this process.”