Everyone backs interoperability, but...

FTC, WEDI, HIMSS, hundreds more weigh in on ONC roadmap
By Bernie Monegain
10:50 AM
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The Federal Trade Commission comments on the proposed government roadmap toward health IT interoperability come with a warning.

"FTC staff supports the development of the Roadmap, which lays out a ten-year plan to increase the adoption of interoperable health information technology systems, the staff at the FTC's Office of Policy Planning, Bureau of Competition, Bureau of Consumer Protection, and Bureau of Economics, wrote in an April 3 letter to ONC chief Karen DeSalvo, MD, in an April 3 letter.

The FTC points out that interoperability could foster innovation and competition in the industry.

The advise from one government agency to another – FTC to ONC – is threefold:

  • Create a supportive business environment that encourages interoperability.
  • Put in place shared governance mechanisms.
  • Work on the advancement of technical standards.

"We respectfully suggest that ONC consider how best to promote competition and innovation when taking steps to speed the adoption of interoperability standards in the marketplace, according to FTC officials.

In its 14-page letter, the FTC notes that the commission has experience on matters of competition, innovation, data security,standardization and interoperability, not only in healthcare, but also in other high-tech markets.

The comments from the FTC are in response to ONC’s request for comments on its draft interoperability roadmap.

The document, Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0 outlines steps "that will enable a majority of individuals and providers across the care continuum to send, receive, find and use a common set of electronic clinical information at the nationwide level by the end of 2017," ONC stated when it released the plan on Jan. 30.

That the ONC is receiving comments from the FTC and from all quarters of healthcare is no surprise. Not only did the ONC ask for public comment, but health IT interoperability has been talked about, worried over and worked upon more than it has ever been in the past 10 years.

Everyone seems to recognize they have a stake.

[See also: 15 interoperability geeks to watch.]

John Loonsk, MD, in his analysis piece published on Healthcare IT News, warned against seven pitfalls as the industry makes its way – yet again – to interoperability, among them reinventing the wheel and trying to rule the road and being distracted by "bright and shiny objects.

"In the past, interoperability has been forestalled numerous times by folks chasing after the next bright and shiny object on the horizon," Loonsk writes. "It is always nice to think that the next standard or technology will be so great that it will become the “only one” and that consistency and interoperability will ensue. Inevitably though, the new standard and technology does not become the “only one,” but becomes “another one” and for a while at least, the environment is even more complicated."

Loonsk, CMIO at CGI and Johns Hopkins Center for Population Health IT, held the position of Director of Interoperability and Standards at ONC between 2005 and 2009.

[Read Loonsk's analysis: 7 traps to skirt on way to interoperability.]

HIMSS officials wrote in their comments that the organization backed the approach that ONC had taken in the roadmap. However, HIMSS warns that execution will require well-coordinated governance.

Also, HIMSS does not support the idea, put forth in the roadmap, that individual consent should be required for use or disclosure of information if individual consent is not required under application law. HIMSS also notes that like other critical infrastructures, healthcare is in dire needs support keeping data secure and to be strong in responding to cyber threats.

[See also: HIMSS weighs in on Interoperability Roadmap.]

HIMSS also called for an "end-to-end process to more rapidly advance interoperability," noting progress on interoperability has been so slow in part because of the marketplace's inability to agree on standards and implementation guidance.

WEDI, the Workgroup for Electronic Data Interchange in its letter to ONC, said that while WEDI supported ONC's efforts on interoperability, the roadmap failed to reflect reality on the ground.

"We would urge the roadmap to better reflect the realities, gaps, challenges and opportunities across the current landscape," WEDI wrote.

WEDI also called for a "sustainable and unified national patient matching strategy. The organization also stated that the industry should tackle basic aspects of clinical data exchange that remain unresolved before the more complex capabilities around patient access to health information and individual choice.

Read the FTC letter here.

Read the HIMSS letter to ONC here.

Read WEDI's letter here.