HITPC subgroup begins work on ‘thorny’ HIE governance

A subgroup charged with forming a governance structure for health data interoperability across networks shared its draft framework at the Health IT Policy Committee (HITPC) meeting as a prelude to formal recommendations expected in mid-October.

“There are thorny issues embedded in all of the work,” subgroup co-chair Carol Robinson, principal at Robinson and Associates Consulting, told the HITPC.

The subgroup is part of the Office of the National Coordinator for Health IT’s (ONC’s) larger 10-year interoperability vision that details three-, six- and ten-year plans to foster widespread health data exchange. Its recommendations are expected to address the substance, scope and processes that ONC should use to establish the “rules of the road” necessary for information to flow efficiently across networks.

“I hear people say 10 years is a long time and that is true. But if you look at goals in a six-year timeframe by 2020, the goals are a highly functional HIE and by 2020, it supports a continuously learning system for research and clinical decision support that is robust,” said Robinson.

Calling the effort “strategically timed,” Robinson noted that both public and private regional and state HIE programs and providers throughout the country are grappling with connecting their own networks and facing challenges establishing governance approaches, aligning technical standards and harmonizing the array of accreditation and certification programs.

Sharing feedback from a five-hour listening session designed to guide the subgroup’s efforts, she cited one organization operating in 22 states that has a full-time staff member solely charged with sorting through the different state laws to ensure compliance.

“The implementation and variation of Direct is just becoming clear in the market,” she added. “It’s disappointing to those of us who continue to be strong supporters of the value of using Direct across a broad-based coordination of care environment. Proprietary standards are also impeding broad interoperability.”

Key takeaways from the listening sessions, she said, include:

• Stakeholders see an important role for ONC in the governance of HIE but have varying perspectives on what that role that should be.
• A number of technology issues are still slowing or inhibiting the exchange of heath data.
• Exchange costs are high and are creating barriers to some providers’ ability to participate. Robinson said the “elephant in the room” is that market forces are a significant barrier to HIE.
• There are varying requirements and interpretations of rules related to the sharing of data, particularly mental health and behavioral data

Robinson summarized suggestions from the listening session as follows:

• Develop a national address book to enable transitions of care and other use cases
• Improve patient matching
• Narrow the goals to enable a deeper focus on developing the standards and policy solutions required to enable interoperability
• At the national level, set common definitions, components, and minimum standards for a strong governance structure from different perspectives and roles
• Develop a common core set of HIE services and standards that support healthcare reform
• Establish minimum and recommended accreditations and certifications

With these data, the subgroup will work on establishing the goals and principles of a governance structure; agree on a set of problems to solve and the governance process needed to solve them; and map structure and process recommendations to ONC’s 10-year interoperability plan, she said.

“This is really a work in progress. I do not want to get ahead of my esteemed colleagues on the subgroup in terms of projecting and predicting  final outcomes… We are just getting to the meat of the conversations,” she said.

Following the presentation, several members expressed concern about the large scope of the subgroup’s work, and that the definition of governance requires more specificity.

Florida state legislator Gayle Harrell suggested the subgroup focus on establishing the entity best in charge of governance, and hash out with similar groups where responsibilities are delineated. “We are about letting a thousand flowers blooms, but we’re getting further down the road in interoperability,” she said. “I’m looking for recommendations and I’m looking for some meat on the bones. It’s not going to be easy but we have to tackle it now.”

Some members suggested tailoring the recommendations to specifically focus on what governance is required to achieve the benchmarks in year three of the interoperability 10-year plan.

Robinson said she did not want the group to narrow their focus too much, though. “We need to make sure we don’t narrow the scope so much we don’t see the forest from the trees,” she said, noting that cross pollination of groups working on HIE challenges “just makes for a richer environment.”

The subgroup is scheduled to present final recommendations on Oct. 15.