ONC unveils interoperability roadmap, first-ever standards advisory

The Office of the National Coordinator for Health Information Technology (ONC) has issued its highly-anticipated roadmap for interoperability.

The 166-page roadmap, “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0.,” builds on the June 2014 vision paper that outlines ONC's 10-year vision for an interoperable health IT infrastructure. It culminates from months of discussions with hundreds of stakeholders, as well as ONC advisory group feedback, listening sessions and an online forum, according to the agency.

Accompanying the roadmap is the Draft 2015 Interoperability Advisory, a document containing the ONC’s assessment of best available standards for implementation specifications for interoperability of clinical data as of December 2014.

The roadmap and advisory dovetail the Department of Health and Human Services’ (HHS) push earlier this week for care delivery reform that would move the industry towards value-based care. “These new models require better data models,” said Karen DeSalvo, MD, MPH, MSc, national coordinator for health IT, during a press briefing. The roadmap “is a pathway to provide new information for that new model to emerge.”

The draft roadmap helps deliver “a world where people have more coordinated care, access to care and information on care and a world where delivery of care is not hindered by old payment models,” she said.

Designed in concert with the Federal Health IT Strategic Plan 2015–2020, the roadmap is based on the following core set of building blocks needed to achieve interoperability:  

1.     Core technical standards and functions;

2.      Certification to support adoption and optimization of health IT products and services;

3.      Privacy and security protections for health information;

4.      Supportive business, clinical, cultural, and regulatory environments; and

5.      Rules of engagement and governance.

In the area of standards, the roadmap not only touches upon issues surrounding vocabulary, format and semantics, but also addresses patient matching and resource location, according to Erica Galvez, ONC interoperability portfolio manager, who also spoke at the briefing. The roadmap also delves into improving consistency of C-CDA and the curation of restful APIs, she said.

Also, the roadmap calls for additional education to help address common misunderstandings related to the federal framework for HIPAA, she said.

In the area of supporting business environments, Galvez said the roadmap “really looks to federal, state and commercial policies that reward providers for outcomes as a key mechanism so it makes business sense.”

The governance section focuses on facilitating interoperability across all regions by establishing “rules of the road” for exchange. “It’s a very clear call to action for stakeholders to come together on an operational level for a single level to really advance interoperability across the nation.”

The release of the standards advisory is a critical component to the roadmap, and answers industry calls for more clarity and consistency on standards. “We’ve heard the time has come to be more explicit about the role of standards,” said DeSalvo.

In his comments, Steven Posnack, director of ONC’s Office of Standards and Technology, said the non-regulatory advisory will be updated yearly and incorporate ongoing feedback from stakeholders. The approach of the advisory is more clearly linking standards to a particular use or outcome, he said.

“It’s really intended to be an all-hands-on-deck experience for ONC, federal partners and those out in the field,” he said.

The release of the roadmap and advisory was largely applauded by representatives of different segments of the healthcare industry.

“The HHS interoperability roadmap announced today is an important step forward for all of us committed to a data-driven approach to improving healthcare. If the public and private sectors will work together on solving the interoperability challenge, we have a chance to significantly improve the practice of medicine and, most importantly, the health of patients across this country,” said Jennifer Covich Bordenick, CEO of the eHealth Initiative.

“While we have made great strides as a nation to improve EHR adoption, we must pivot towards true interoperability based on clear, defined and enforceable standards,” said CHIME President and CEO Russell P. Branzell, in a statement. “This roadmap incorporates a tremendous amount of stakeholder input and articulates a clear path towards interoperability. It is a cornerstone in the continuing evolution of federal health IT policymaking.”

Debra L. Ness, president, National Partnership for Women & Families, also applauded the draft roadmap. It’s “a very welcome, very promising and very smart next step in the effort to create a health IT system that will make healthcare more patient- and family-centered in this country. We are especially pleased that the new roadmap focuses on interoperability not just among providers, but also patients and their family caregivers, recognizing them as equal partners in the continuum of care and in electronic access to and use of health information.”

The roadmap “will help guide our progress toward seamless integration of HER data,” said Christopher Miller, program executive officer for Defense Healthcare Management Systems within the Department of Defense. “We are proud to be working closely with ONC and other public and private partners to ensure that our healthcare providers have a complete picture of health information from all sources

Access the draft roadmap and standards advisory. 

The public comment period closes on April 3 for the draft roadmap and May 1 for the Standards Advisory.