ONC leaders share roadmap thought process

WASHINGTON, D.C.—The eagerly anticipated interoperability roadmap is a “meaty document,” National Coordinator Karen DeSalvo, MD, MPH, MSc, said at the ONC 2015 Annual Meeting.

“The President is committed to seeing that we achieve interoperability,” she said, adding that it’s a priority for several federal partners as well.

Several ONC leaders shared more details about the roadmap and the Interoperability Standards Advisory (ISA).

Since the average Medicare beneficiary sees two primary care providers and five specialists a year, there is a need for information flow within and outside care delivery, said Erica Galvez, ONC’s interoperability and exchange portfolio manager.

“Measuring our progress and tracking what we’re doing is critical,” she said, so the roadmap includes a measurement framework. There are areas around capability of not only technology but to use information and interoperate across different settings for impact in both process and outcomes, she added.

The team considered consent management which evolved to computable privacy, said Lucia Savage, ONC’s chief privacy officer. The goal is to “have computers do this for us. We can write rules and computers can carry them out. You can have all the technical standards in the world but if you’re collecting consent with a pen the whole system comes to a screeching halt.”

Legal harmonization needs to occur, she said. “We have the technology. We need to know what to build. To know what to build, we need more harmony amongst the things.”

Computable privacy starts with permitted uses, explained Savage. Comparing it to trusts and estates, she said if there is a disaster today and no one had a will, there are rules already in the system that would manage our personal property. These background rules operate whether we do anything. HIPAA has background rules we need to capitalize on and realize they don’t impede interoperable exchange.

The ISA came about as the result of all the questions staff were getting about standards, said Steven Posnack, MS, MHS, director of ONC’s Office of Standards and Technology. “Why you want interoperability matters. It’s got to be an important part of the conversation. What purpose or outcome is desired? We owe it to ourselves to get specific.”

Different combinations of standards often are needed to achieve the desired outcome. He challenged the audience to bring a level of specificity to all discussions.

The ISA represents ONC’s best thinking, said Posnack, and is “as much an acknowledgement as it is an honest assessment” of what’s available. “We have the standards. Let’s put them to use.”

Staff aimed to keep the ISA simple and have it create common ground, he said. It’s a single public list of standards meant to prompt dialogue, debate and consensus.

The widely vetted resource will be updated annually in December, he said. ONC envisions it translating into government actions related to procurement, testing and certification programs and standards development. He said they anticipate that it will help “gain momentum toward common purposes we’d like to achieve.”

The ISA includes four sections: vocabulary, content and structure, transport standards and services. “We know, in most cases, standards that will be necessary to meet a desired interoperability use case will need to be combined in a cumulative fashion.”

“We need feedback. Don’t be an interoperability bystander.”