Redirecting ONC’s interoperability roadmap

The draft interoperability roadmap released by the Office of the National Coordinator for Health IT contains so many details in its 166-pages that has been called “meaningful use on steroids.”

The roadmap draft appeared in late January to coincide with the ONC National Meeting, which focused largely on interoperability. The document’s language indicates that agency officials appear set to get the healthcare industry to once again place a high priority on becoming interoperable, says Dan Golder, principal of Naperville, Ill.-based Impact Advisers.

“The roadmap is meaningful use on steroids,” he said. “There is quite a bit in there, but every page has a lot in it that is worthwhile. It is still a draft, so it is influenced by comments. It will be interesting to see how that plays in the next couple of months.”

“The roadmap is meaningful use on steroids,” he said. “There is quite a bit in there, but every page has a lot in it that is worthwhile. It is still a draft, so it is influenced by comments. It will be interesting to see how that plays in the next couple of months.”

Golder senses a shift in tone away from the meaningful use that has preoccupied healthcare organizations and putting emphasis back on interoperability.

“I look at this and say ONC cut its teeth on meaningful use and this is the next logical step forward,” he said. “I’m interested to see how these two tie together.”

To be sure, healthcare is entering “a very interesting era,” adds Harry Greenspun, MD, director of the Deloitte Center for Health Solutions in New York.

“It has moved along from the era of EHR adoptions to the era of impatience,” he said. “Tremendous investment has been made in IT systems, EHRs and medical devices. They’ve got the data flowing, but with consolidation of provider organizations, they need a clean installation of IT across these newly formed systems.

“It brings up questions about how to advance interoperability – health information exchanges, EHR vendors, or a private platform?” he added. “It’s an era where everyone is getting impatient.”

Greenspun says he finds it “curious” that the ONC roadmap focuses exclusively on EHRs and not on medical devices.

“We’re seeing provider-led organizations saying this is costing us money and is a patient safety issue,” he said. “Some believe the industry has gone too slow and that providers need to leverage their collective buying power to force the issue. It is coming to a head because EHRs are in place and they don’t want to live in a world where plastic is substituted for paper.”

IHE is ‘critical’
The IHE North American Connectathon is where interoperability gets an annual test of progress, functionality and success every January. After 16 years in Chicago, the event moved to the new co-facilities of the Cleveland Convention Center and Global Center for Health Innovation, home of the HIMSS Innovation Center.

Besides serving as one of the public sector participants, the ONC cited the IHE Connectathon and IHE Profiles as “critical components to enable interoperability” in both the draft Interoperability roadmap on Jan. 28 and the 2015 Interoperability Standards Advisory on Jan. 30.

This year’s event featured 98 participating organizations, 148 tested health IT systems and 555 on-site participants with 19 percent international attendance. In collaboration with the Connectathon, 78 vendors will be demonstrating more than 100 health IT systems at the HIMSS15 Interoperability Showcase in Chicago in April.

“IHE is known for its technical specifications that form the foundation of interoperability and data exchange, its broad industry expertise and its experience in system-to-system testing and certification,” said Joyce Sensmeier, president of IHE USA. “What the world is discovering is IHE’s value as a leader in advancing standards-based interoperability in the marketplace.”

Population principles
Phillip Burgher, director of software development, data platforms and PQRS at Alpharetta, Ga.-based Wellcentive considers the ONC documents to be “very well written and concise statements of the problems we face in the industry.” Vendors, he said, “now have something to lean on for standards we want to use.”

The ONC guidelines address best practices, but don’t address the business model for interoperability, he said. That is where a third piece, the recent HHS announcement on value-based reimbursement, fills in the void. “You must have a purpose – interoperability for interoperability’s sake won’t work,” Burgher said. “If you connect the dots, you do it with analytics and population health and measure how you want to do it. Interoperability is how you do population health.”

The conversation, he says, needs to be extended from the patient and provider levels to the population level.

“Interoperability is very EHR centric – but EHRs are not the only source of data you need for population health – you need to tie in the whole ecosystem,” he said. “It is not a technology issue, it’s a business issue.”

The HIE factor
Just as interoperability needs renewed interest from healthcare providers, so do health information exchanges, says Scott Whyte, senior vice president of growth and innovation for Tempe, Ariz.-based Cleardata.

“Hospitals want to have good relations with physicians, who sometimes feel separated,” he said. “The HIE helps keep them connected. Primary care physicians keep apprised of EMRs and that aligns with accountable care and demonstrates they are providing good outcomes.”

Before joining Cleardata, Whyte helped build one of the largest private HIEs in the country at San Francisco-based Dignity Health. The network includes 8,500 physicians and extends over three states as a platform for population health and accountable care.

The key to growing a strong HIE, Whyte says, is agility, security and scalability. But while they have made strides in advocacy, generating outcomes and fostering understanding of population health, HIEs still have obstacles to overcome.

“There are gaps – the biggest are upstream,” he said. “If measuring improved health is what we want to do, we need to look at delivery and the problems with EMRs, content management and outcomes. The whole issue of interoperability plays into that very much.”

Engaging LTC
Long entrenched at the lowest rung of the healthcare provider ladder, long-term care and post-acute care providers are getting new opportunities in the value-based healthcare business model as part of emerging accountable care organizations. It is a space that greatly interests Salt Lake City, Utah-based VorroHealth.

“We are shifting to the LTPAC space – over the next two or three years it will really start moving,” says Billy Waldrop, vice president of operations. “Our company is focused on engaging, pairing, and connecting with long-term care interoperability. The aging population is bringing in more people to that space. We are bringing technology to the table – applying a methodology to get things done without being overly complex. The long-term care space is wide open.”