Go easy on Stage 3 MU, says JASON group

'Reducing the breadth of MU requirements to focus on use cases demanding interoperability will free up provider and vendor resources'

By Mike Miliard
11:10 AM
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It's imperative for the success of interoperability that Stage 3 meaningful use be less stringent, giving health IT vendors the necessary latitude to develop innovative products, according to a draft report from ONC's joint HIT Policy and Standards Committee JASON task force.

[See also: Interoperability: supply and demand]

In a draft of the JASON task force's final report, due to be submitted to the Office of the National Coordinator for Health IT, the advisory group offered its recommendations for building off assessment of the initial JASON report (PDF), which concluded what many in healthcare had already susected: that Stages 1 and 2 have failed to foster interoperability "in any practical sense."

This can be blamed on a lack of a comprehensive nationwide architecture for health information exchange, ingrained EHR technology and business practices  and more systemic impediments, such as lack of incentive for data sharing.

[See also: Stage 3 MU now in the making]

Toward that end, the JASON report calls for redoubled efforts toward a unified interoperability architecture, to move data from legacy IT systems to "a new centrally orchestrated architecture to better serve clinical care, research and patient uses."

Specifically, this architecture would be based on the use of public application programming interfaces for access to clinical documents and discrete data from EHRs, according to the report – alongside broader "consumer control of how data is used."

The draft offers a series of recommendations based upon the task force's reading of the JASON report.

The task force – co-chaired by Micky Tripathi, CEO of the Massachusetts eHealth Collaborative, and David McCallie, senior vice president of medical informatics at Cerner – makes the case that ONC should "take immediate actions to motivate a public-private vision and roadmap" for a nationwide architecture for data exchange – an effort that, ideally, would nudge market forces toward developing "data sharing networks that would deploy public API that would expose core data services and core data profiles."

Specifically, "in order to allow vendors and providers to focus their efforts on interoperability, CMS and ONC should narrow the scope of MU Stage 3 and associated certification to focus on interoperability in return for higher requirements for interoperability," the report reads.

This would better enable both vendors and providers to concentrate on "high value use cases leveraging Public APIs," which require "concentrated development work in order to accelerate their market and certification readiness."

In contrast, Stage 2 meaningful use and the prescriptive 2014 edition certification criteria have "demonstrated that there is a tradeoff between the complexity of requirements and the ability of most vendors and providers to stay with MU timelines," the report finds. "Reducing the breadth of MU requirements to focus on use cases demanding interoperability will free up provider and vendor resources to implement and adopt public APIs."

Among the other recommendations developed by the JASON task force.

  • That a coordinated architecture be "defined to meet the nation’s current and future interoperability needs, rather than an architecture defined and controlled from the top-down."
  • That such a coordinated architecture be based on a public API, which would "enable data- and document-level access to EHR-based information in accordance with modern interoperability design principles and patterns."
  • That the public API "implement a set of rigorously defined core data services, which should be selected to expose key data access functions for high value healthcare interoperability use cases."
  • That the coordinated architecture uses of the public API  should support data sharing networks "that promote EHR-to-EHR interchange, and consumer access to the core data services via patient portals."
  • That CMS and ONC leverage Stage 3 to motivate private sector development of a coordinated architecture based on public APIs and focused on provider and consumer use cases.
  • That ONC "aggressively monitor the progress of exchange across data sharing networks and consider an incremental range of interventions to accelerate cross-DSN exchange if the market does not enable such exchange on its own."

[See also: Interoperability 'taking so darn long']