ONC Annual Meeting: Market now demanding interoperability

Interoperability differs from exchange, even though the terms often are used interchangedly, said Doug Fridsma, MD, PhD, chief science officer and director of the Office of the National Coordinator for Health IT’s Office of Science & Technology, at the organization’s Jan. 23 annual meeting.

Interoperability is the ability of two or more systems to exchange information and then use the information that’s been exchanged, said Fridsma. “That’s powerful because that simple definition gets us to the right conversation. We need exchange before we can be interoperable.”

“We have made tremendous progress,” said Arien Malec, vice president of clinical solutions strategy for Relay Health, a unit of McKesson. “We have an ecosystem where two providers can send information securely.” Despite the progress, “it’s nowhere near far enough.”

Malec also said we are seeing a sea change because Meaningful Use (MU) Stage 1 raised the bar in terms of the number of providers enabled with electronic data capture. Payment system reform is starting to move healthcare away from optimizing single settings of care, he said. “We’re starting to see people clamor for data pooled for analytics and for data to be used for clinical decision support. We are going from the government pushing people to now seeing pull from the healthcare sector."

When asked about the greatest challenges with interoperability, Malec said healthcare is experiencing “the last mile problem. We have made some tremendous strides” but it’s still hard to get EHRs configured for the interfaces providers want.

Dave Whitlinger, executive director of the New York eHealth Collaborative, said his organization has a backlog of more than 300 providers looking to get connected to the network. “That’s with my team churning out 1.4 connections a day because this stuff is so hard to connect. Demand for HIE is growing and growing but tens of thousands of dollars to connect is ridiculous. Why are we not at plug and play?”

The demand for interoperability “puts the pressure on,” he added, but it’s time to “get on with it and start to employ strategies that other high-tech sectors have done in the past.

“Vendors and standards development organizations oftentimes treat success as conformance to the standards,” said Fridsma. “That’s necessary but not sufficient to get to interoperability. You need to make sure you can receive any of the versions that are out there.” ONC continues to drive toward not just conforming to a standard but actually demonstrating interoperability, he added.

ONC stepped back and the community stepped up and put together a tough but fair certification process, said Malec. “If ONC can be a convener but the community can pull and take and own, that’s what success looks like from a policy perspective.”

With Meaningful Use, ICD-10 and other mandates facing providers, Malec said some alignment would be helpful so providers can be more focused on improving care and less focused on how to meet programmatic requirements.

Fridsma agreed. “We’ll always have to pay attention to the value of what we’re asking people to do and make sure there is a good payoff for the patients in the end.”

Karen DeSalvo, MD, MPH, MSc, new national coordinator for health IT, asked the panelists whether the business and employee communities are pushing interoperability as a way of reducing costs. Malec said employers are the ultimate payers of care and are realizing that care is paid for the wrong way. They are now starting to think, he said, that they should pay for quality and interoperability will sort itself out.

The numbers certainly support greater interoperability, according to Whitlinger. One of the more mature HIEs in New York did a study on more than half of the participating providers. Overall, they experienced a 30 percent reduction in redundant labs, imaging studies and avoidable ED visits. “The system pays for all the waste. The business community in Rochester said they are not going to pay for redundant services anymore.”