ONC announces grants to further HIE, interoperability

The Office of the National Coordinator of Health IT announced two new cooperative agreements designed to further support of growth of health information exchange (HIE) and interoperability. DirectTrust.org received a one-year contract for $280,000 and the New York eHealth Collaborative received a one-year contract valued at $200,000.

The contracts will focus on progress toward governance. The ONC issued an RFI proposing an optional governance mechanism for the nationwide HIE network but, during a media briefing, Claudia Williams, director of the ONC’s state HIE program, said the feedback received made them reconsider.

People told ONC that “since there are so many ongoing activities in this space, lend your weight to increasing those existing activities rather than creating a new effort,” Williams said. “We decided not to move forward with new regulations but instead launch a wide range of efforts to support and learn from existing initiatives and advance HIE goals such as increase interoperability, decrease cost and complexity and increase trust among participants and the public to mobilize HIE.”

ONC will work with the two organizations selected to develop policies, interoperability requirements and business processes that align with goals and reduce implementation costs, Williams said. “This gives us the opportunity to urge many of our partners across the nation to participate actively and robustly support the work of these two grantees.”

DirectTrust has been working with about 45 entities to create a set of policies and an accreditation program, said David C. Kibbe, MD, MBA, president and CEO. “Directed exchange is designed to be as easy as email. We use the same process to send messages and move data where we want to between known parties. The big difference is that in healthcare, when information is exchanged, it needs to be private, secure, and users need to have trust in the identity of the person or organizations with whom the information is exchanged.”

The liabilities and risks around privacy and security have to be very tightly assured, said Kibbe, and that’s where DirectTrust comes in. The group of volunteers has been “working to develop a set of standards, policies and procedures around privacy and security, trust and identity so participants can be comfortable and have confidence that those exchanges will remain encrypted and won’t be sent to the wrong people.” The work already conducted on a security and trust framework will serve as the basis of an accreditation program being used by several HISPs and certification and regulatory authorities--trusted agents--who act on behalf of Direct email users.

The framework was developed in partnership with the Electronic Healthcare Network Accreditation Commission (EHNAC). “We now have approximately 12 entities undergoing the accreditation program and would like to see many more as the year progresses,” said Kibbe. The grant will be used to further that work and to advance ancillary activities such as distribution of trust anchor bundles which allow trust agents to not have to engage in costly and cumbersome contracts with one another “so exchange can be seamless, easy to use and ubiquitous for the parties who wish to exchange in this manner. A year from now, our hope is that EHR A can communicate with EHR B and providers and patients who use these systems can more freely but also very securely transfer their information.”

The New York eHealth Collaborative formed its Interoperability Work Group in 2011, said David Whitlinger, executive director, during the media briefing. They learned that many HIEs were facing similar problems, such as the ability to get the EHR and the HIE connected to each other and working together in a consistent, inexpensive way.

Those problems present a difficult proposition, Whitlinger said. To manage, they assembled EHR vendors, state HIEs and the HIE vendors who were also starting to feel that they would benefit from some standardization. The group decided that the two areas most useful to address with regard to standards were Directed exchange and query-based exchange, also known as patient record lookup. The group established goals of developing technical specifications, testing methods and the marketing logo “such that we could get to plug and play interoperability and market to the physician community the products they could purchase that have that interoperability.”

The idea is interoperability out of the box with their local HIE so that “physicians no longer have to become ad hoc engineers and HL7 gurus to get their EHR into a network,” said Whitlinger.  

The test program has been launched and the industry can expect to start seeing logoed products this fall, he said. Nineteen states are participating, along with 20 EHR vendors and 22 HIE vendors—“a broad coalition set on this plug and play standard.

Teaming up the two organizations is an important part of the interactivity between various networks across the country. The grants “ultimately get us to a place where we will see the free exchange of records across the country,” said Whitlinger.