Interoperability roadmap comments include praise, concern, recommendations

The Office of the National Coordinator for Health IT's (ONC) draft interoperability roadmap drew a wide range of support and criticism as the public comment period came to a close on April 3. 

The American Hospital Association (AHA) said it supported ONC's goal of creating an interoperable health IT infrastructure but raised concern about the roadmap.

Hospitals and health systems have reported that EHR system technology does not support seamless data exchange, said Linda Fishman, AHA's senior vice president of public policy analysis and development. "The cost and complexity of the many interfaces needed to connect systems today are simply not sustainable," she said.

AHA recommended that ONC mark the "starting point" of the interoperability roadmap, including current requirements under Meaningful Use and the functionalities of 2014 Edition certified EHRs.

The American Medical Association (AMA) offered several recommendations to ONC including:

• Acknowledge the effect of Meaningful Use on interoperability;
• Address barriers to interoperability, including those related to costs and EHR usability;
• Avoid using a disciplinary approach on providers;
• Continue to foster private-sector governance efforts; and
• Prioritize "cornerstone" interoperability issues, such as functional standards and clinical data definitions

The Workgroup for Electronic Data Interchange strongly supports ONC’s efforts to establish an interoperability roadmap, but called on ONC to “better reflect the realities, gaps, challenges and opportunities across the current landscape.”

The organization recently conducted a survey that found significant barriers to interoperable electronic data exchange among providers, health plans and vendors. Those barriers along with competing industry priorities led to WEDI declaring the proposed timing and scope of the roadmap’s critical actions for both public and private stakeholders “aggressive.” Priority setting is needed, they said. “WEDI believes that the healthcare industry is still working onimplementing the basic infrastructure in order to support the exchange of electronic health data. Given the nascent state of these efforts, and in light of competing deadlines (e.g. ICD-10, Administrative Simplification provisions, etc.), WEDI would encourage ONC to develop a prioritized list of actions andindividual stakeholder assignments that can be achieved with reasonable effort.”

WEDI also noted a need to move from government oversight to industry involvement. While ONC has "played a key role in driving the development and adoption of core building blocks and standards for health information technology,” the nation is moving "into a more mature phase of building a health IT infrastructure." WEDI cited the success of Healtheway as one example of how public-private collaboration can drive efforts forward.

In its comments, the Electronic Healthcare Network Accreditation Commission (EHNAC) focused on the accreditation process for organizations and health IT products in the areas of privacy, security and confidentiality. The group said it supports ONC's plans to use certification and testing to support adoption and optimization of health IT products but called for even more.

“The range of functions, ease of use, vendor support and product platforms are all key issues for users of IT products,” EHNAC wrote. “In addition to ‘base’ certification of standards, we would also recommend that ONC confer and include vendor and user groups to help define best practices for IT products to meet, especially in the realm of interoperability.”

At the same time, EHNAC asserts that there is a need to streamline the plethora of certification/accreditation programs that currently exist. “It will be important for ONC to recognize and work closely with other certification/accreditation programs to reduce any duplication of effort on the part of stakeholders and to align, as closely as possible, requirements among programs.”

EHNAC also recommended that ONC “allow entities to choose the certifications/accreditations they wish to achieve” and that it should be the “decision of the users of products to determine what certifications/accreditations they feel are necessary for a product in determining compliance with privacy, security and confidentiality to minimize exposure and risk of a breach or incident.” The organization warned that a “one-size-fit-all” approach will only lead to “complex and over-architected” products which may contain features not necessary to a wide range of users.

CHIME and AMDIS submitted their comments jointly, commending ONC for "creating heightened visibility toward building an interoperable health IT environment and underscoring the importance of clear, enforceable standards. For too long our fractured industry has developed tools based on a moving target of immature and inconsistently implemented standards."

The groups called for ONC to take seriously the need to prioritize action items which can build on progress made to date. Interoperability in the service of high quality, safe patient care should remain the top, near-term goal, they said, specifically calling for a focus on patient identification. "A national approach to patient identification is prerequisite for interoperability and the lack of a standard patient identifier only serves to aggravate our industry’s technical challenges. Without a standard patient identifier, the creation of a longitudinal care record, composed of data created through disparate systems, geographies and chronology is simply not feasible."