HITPC governance workgroup calls for public-private consortium

A Health IT Policy Committee subgroup is calling for a public-private collaborative consortium to handle the intricacies of health information exchange (HIE) governance.

The Interoperability and HIE Workgroup’s governance subgroup—co-chaired by Chris Lehmann, Vanderbilt School of Medicine in Nashville, and Carol Robinson, principal at Robinson and Associates Consulting—conducted two listening sessions with a variety of stakeholders to determine what activities federal health agencies should take to advance interoperability.

Among its many findings, the subgroup called on the Office of the National Coordinator for Health IT (ONC) to form a public-private collaborative consortium which would:

• Be modeled from a best practices review of other nonprofit, government-deemed organizations;
• Include the evaluation of technical, operational, financial and policy issues impeding interoperability or threatening the security of protected health information in HIE, and apply governance levers where needed;
• Include a well balanced and appropriate representation of stakeholders; and
• Carefully balance government involvement to ensure stakeholder buy-in.

“We didn’t want to be too prescriptive, but wanted to give ideas on it,” said Robinson.

The consortium’s work would take into consideration market-based use cases, which will evolve over time, she said. “As we envision how this would be put together, we didn’t want to start with prescriptive Band-Aids by identifying use cases but establish processes that would be repeatable over time, including processes for prioritizing, with some potential ability to regulate.”

The subgroup’s other suggested actions for ONC included:

• Developing a Governance Framework for Trusted HIE and guidance on important national interoperability issues to support alignment and convergence in the marketplace;
• Aligning federal activities with the ONC's interoperability guidance;
• An education campaign encouraging entities to adopt and use HIE for clinical and administrative uses; and
• Develop a mechanism to track and measure progress in HIE as part of the interoperability roadmap.

The subgroup listed a number of federal levers to include the speed and adoption of exchange, including all agencies that provide or pay for healthcare.

At a joint Health IT Policy and Standards Committee meeting, some members did not like the idea of a consortium.

“Appointing another body won’t get us to another level,” said Devon McGraw, partner at Manatt, Phelps & Phillips, who said she would prefer very specific recommendation to fill certain gaps in data exchange. Without knowing those challenges, “these discussions could go on forever.”

She added that consortiums have a “pay-to-play” membership model, and that no membership body is going to make difficult decisions because of fear of losing members.

Marc Probst, CIO of Intermountain Healthcare, agreed and suggested that the federal government should play a larger role. “Peoples’ lives are being lost every day. We need urgency and we need to get solutions. I’ve been sitting in groups like this for three years saying the same thing,” he said. Noting that the country has highways that run through every state, the same could be done for HIE. “The federal government is able to make things happen.”

Jodi Daniel, director of ONC's Office of Policy, said “this is really important work that will help us flesh out the rules of the road.” These recommendations will be considered among the full HIE and Interoperability Workgroup as ONC gears up to publish the interoperability roadmap early next year.