The ONC's new Interoperability Roadmap—the federal guidebook that calls on the healthcare industry to work out the kinks that keep information from flowing between disparate systems—is more ambitious than many plans that came before it.
But while the document, technically titled "Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0," offers greater details on how providers can move toward interoperability, technology and implementation challenges loom large. In other words, achieving all of the document's goals in the next five years might be more challenging than the ONC suggests.
A good foundation
"Like any document from the feds there's a lot of enthusiasm," Jeff Loughlin, program director of the Massachusetts eHealth Collaborative, told Healthcare Dive. The Direct Project standards, put out as part of the Nationwide Health Information Network in 2010, were "a great starting block," Loughlin says, but did not provide complete implementation guides. This omission left a lot of interoperability gaps between various vendors who interpreted the guidelines differently.
"The gap has been widened in the past few years because of the misalignment between the incentive timelines for hospitals and providers so the need and demand for exchange services have not always been in sync," Loughlin said.
The new Roadmap in the first 40 pages purports to flesh out details on how it will bring government and private industry stakeholders together to collaborate on more finite standards that leave less room for interpretation. Specifically, the Roadmap calls for establishing "policies for identifying and addressing bad actors and to identify the technical standards that will enable interoperability for specific use cases."
Loughlin believes that those who read the document will find it lays a good foundation for vendors and the government to collaborate.
"The new principle for interoperability now tries to identify both functional and business requirements, recognizing that one size does not fit all, and allows for increased modularity," says Loughlin. "This should better allow the market to help drive the improvement and innovation process."
"[The Roadmap] is a much-needed playbook for each and every health IT professional," Russell Branzell, CEO of the College of Healthcare Information Management Executives told Modern Healthcare. "Now, healthcare providers and health IT developers have a single source of truth, with an extensible process to align clinical standards towards improved interoperability, efficiency and patient safety."
Limitations and challenges
But while the new Roamap pushes focus beyond institutional care delivery and healthcare providers, to a broad view of person-centered health, specific plans to ensure that post-acute care, long-term care and other types of healthcare organizations are included in the process of development would strengthen the document, Branzell added.
Also, when it comes to following the Roadmap, there are other challenges.
"We need to start to think a little more holistically about patient care, and that it doesn't necessarily stick to state lines," says Loughlin. "The states obviously have the right to design their own procedures to manage [data flow], but interoperability comes into play because organizations have to be able to send information across state lines to follow clinical care or business requirements, and we can't always let state or local governments dictate how that happens."
Jeff Lin, senior vice president of product management for InstaMed, a health IT vendor, agrees that the document is a good starting point.
"There are some definite positives here, for instance, with the technical consistencies, the plans for developing a common language," Lin told Healthcare Dive.
However, adds Lin, "the big question I have is 'how do you drive the consumer engagement?' Interoperability is all about sharing information. What's the incentive for the consumer to share this information?"
Lin says the Roadmap would benefit from the addition of ideas for developing a universal language that allows consumers to engage with their healthcare providers in meaningful way—not just healthcare providers to coordinate care with one another.
"The [consumer engagement piece is] important because that's what's going to drive providers and payers to work toward a common language," he says.
ONC is currently accepting public comments on the draft Roadmap through April 3, 2015.