May 15

USA- ONC ‘making progress’ on interoperability roadmap



The Office of the National Coordinator for Health Information Technology (ONC) is on its way – as best it can tell – to hitting its three-year goals laid out in the January 2015 draft interoperability roadmap. Karen DeSalvo said, “The linear trajectory shows they are making progress.” ONC had ambitiously stated that by the end of 2017 patients and providers would be able to “send, receive, find and use priority data domains to improve health care quality and outcomes” Politico reported last month.


3 major outcomes the roadmap is looking at achieving

  • For Individuals to have access to longitudinal electronic health information; and contribute to that information and can directing it to any electronic location.
  • Provider workflows and practices include consistent sharing and use of patient information from all available and relevant sources.
  • Tracking progress and measuring success.

3 major achievements

  • Electronic Health Record (EHR) Incentive Program which has seen more than 97 percent of hospitals and three quarters of physician offices now wired.
  • Establishing a “network of networks,” which will further ONC’s information-exchange goals. Such as the work of the Strategic Health Information Exchange Collaborative (SHIEC). A national trade association of about 40 HIEs, it’s working to connect exchanges and finding good overlap in governance, standards and patient consent.
  • Now establishing incentives transitioning from Measuring Clicks to Focusing on Care. Change the focus from access to technology to achieve outcomes from the technology.

However, ONC has reported to congress that interoperability is still lagging. Although 75 percent of hospitals exchanged health data in 2014, few physicians engaged in the practice. Only 42 percent of physicians exchanged health data with providers within their organization, and only 26 percent exchanged with those outside of their organization. They cited a lack of standards as one of the primary reason for lack of overall health IT interoperability, with insufficient specificity when it comes to standards implementation and not enough industry-wide testing of standards prior to nationwide deployment.

What will be next? While the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) continues to require that physicians be measured on their meaningful use of certified EHR technology for purposes of determining their Medicare payments, indications are that new incentives will be developed to move to a more outcome focused rewards system.  They list several critical principles to guide this work:

  • Rewarding providers for the outcomes technology helps them achieve with their patients.
  • Allowing providers the flexibility to customize health IT to their individual practice needs.
  • Levelling the technology playing field to promote innovation, including for start-ups and new entrants, by unlocking electronic health information through open APIs – technology tools that underpin many consumer applications.
  • Prioritizing interoperability by implementing federally recognized, national interoperability standards and focusing on real-world uses of technology, like ensuring continuity of care during referrals or finding ways for patients to engage in their own care.

These new incentives when developed will have a ripple effect around the world as the big EMR vendors again focus on helping their US clients gain these incentives.  With a greater focus on interoperability and how new apps, analytic tools and plug-ins can be easily connected to their data , it definitely looks like it will move in the right direction. Let’s hope the big vendors can also keep up with the needs of other countries as well.


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