Impatient for interoperability, GOP senators target ONC plan

Hit roadmap as lacking in 'nitty-gritty technology specifics'
By Bernie Monegain
10:56 AM
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Five Republican senators -- the same group that in 2013 called for a "reboot" of the HITECH Act -- are pressing on with their efforts to drive changes in how health IT is deployed, especially with regard to interoperability.

[See also: Republican senators seek ways to improve HITECH implementation.]

GOP Sens. John Thune of South Dakota, Lamar Alexander of Tennessee, Pat Roberts of Kansas, Richard Burr of North Carolina and Mike Enzi of Wyoming, co-authored a blog that appeared March 4 on Health Affairs, titled, "Where is HITECH's $35 Billion Dollar Investment Going?"

"Two years after releasing the white paper, and six years since enactment of the HITECH Act, the question remains," they write. There is inconclusive evidence that the program has achieved its goals of increasing efficiency, reducing costs, and improving the quality of care."

The senators appear to be especially annoyed by the lack of progress on interoperability.

"We have been candid about the key reason for the lackluster performance of this stimulus program: the lack of progress toward interoperability," they write. "Countless electronic health record vendors, hospital leaders, physicians, researchers, and thought leaders have told us time and again that interoperability is necessary to achieve the promise of a more efficient health system for patients, providers, and taxpayers."

They also criticized the draft interoperability plan released by ONC on Jan. 15 for speaking in "generalities."

"The ONC roadmap provides a framework for responsibility, governance, and accountability in regard to the future development and implementation of interoperable EHRs," they write. "But instead of offering specific objectives, deadlines, and action items, ONC’s roadmap falls short on the nitty-gritty technology specifics that vendors and providers need when developing IT products. We are left with many outstanding questions about how to achieve interoperability and how to address the cost, oversight, privacy, and sustainability of the meaningful use program."

In a think piece published March 5, Niam Yaraghi a fellow at the Brookings Institution's Center for Technology Innovation, puts forth a counter point to the issues the senators raise.

"While I agree with the Senators that the health care IT system is currently not performing well, I do not believe they have realistic expectations for ONC," he writes. "Congress must realize that the national health care IT system is not broken, rather it was build this way. HITECH was designed with a lack of insight into how the health care market functions and thus billions of dollars were doomed to be wasted and have no tangible return from the very first day."

Yaraghi goes on to discuss a "huge gap" between the intended goals of the legislation and its implementation strategies.

"Legislators had incorrectly assumed that medical providers would engage in information exchange if they were provided with the technical capability to do so," he writes. "They failed to understand that in the current financial structure of the health care system, there is hardly anyone who wants to exchange information even if it was technically possible."

ONC is accepting public comments on the draft plan until  5 p.m. ET on April 3, 2015, and has received hundreds already.

In her letter at the start of the roadmap, DeSalvo emphasizes that several action steps will be needed on the road to interoperability. The work, she writes, will occur along three critical pathways:

  1. Requiring standards;
  2. Motivating the use of those standards through appropriate incentives; and
  3. Creating a trusted environment for the collecting, sharing and using of electronic health information

The roadmap "will require us to agree to a set of rules of engagement that will bring trust to the system for consumers and others," she wrote.

[See also: ONC calls for interoperability by 2017.]