Interoperability: for real this time?

Some believe the momentum is right – at long last
By Bernie Monegain
11:21 AM
Glenn Tobin, of The Advisory Board Company weighs in on interopeability.

When the Office of the National Coordinator released a draft health IT interoperability roadmap for the nation last week, it sparked optimism from some quarters, and also a 'wait-and-see,' approach from others.

The "time has come for us to be more explicit about standards," said ONC Chief Karen DeSalvo, MD, in a Jan. 30 press call detailing the roadmap, a 150-page plus document addressing everything from governance, standards and certification to privacy and security. "Health IT that facilitates the secure, efficient and effective sharing and use of electronic health information when and where it is needed is essential to better care, smarter spending and a healthier nation," DeSalvo said.

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

Glenn Tobin, of The Advisory Board Company, is among the optimists.

"I thought it was great," he said, when asked for his first reaction.

"There's actually a lot of momentum already built up around the new standard with HL7," he said. "All of the FIHR stuff is very robust. There's a lot of work to do to make it all work out. There is also a very large industry collaborative under way to try to figure out how to implement it in a much more rapid way than would typically happen in a first standard-setting process."

Tobin was referring to the Argonaut Project – a collaborative that includes both providers and vendors, such as Epic, Cerner, MEDITECH, Mayo Clinic, Intermountain and Partners HealthCare.

[See also: Epic, Cerner, others join HL7 project.]

"FHIR is such a significant advance in accessing data, delivering data and the enormous, enormous flexibility inherent in the model," Charles Jaffe, MD, said in an Oct. 14, 2014 interview with Healthcare IT News.

He blames a stuck-in-the-past approach for the slow pace of progress to date.

"We embrace a lot of technology that is technology for the past and ways of doing things that were important in the past rather than understanding the ideas that fundamentally change the way we achieve interoperability," he said.

[See also: Interoperability's 'game-changer'.]

John Loonsk, MD, has given interoperability a lot of thought over the years. He held the position of Director of Interoperability and Standards at ONC between 2005 and 2009; today he is CMIO at CGI and Johns Hopkins Center for Population Health IT.

"The Roadmap is a sweeping piece of work and an impressive accomplishment," he said in an e-mail statement when asked for his first take on the roadmap.

"It is hard not to notice, though too, that it was released at the same moment that the HITECH - Meaningful Use incentive was being dialed-back. Although Meaningful Use has not focused primarily on interoperability, the mobilization of health information suggested in the Roadmap will require numerous large incentives and HITECH MU was the biggest incentive we have had."

Loonsk is at work on a column that takes a deeper dive into the draft roadmap.

"While we have made great strides as a nation to improve EHR adoption, we must pivot towards true interoperability based on clear, defined and enforceable standards," said CHIME President and CEO Russell P. Branzell, in a statement. "This Roadmap incorporates a tremendous amount of stakeholder input and articulates a clear path towards interoperability."

The Department of Defense weighed in with a statement:

"ONC's interoperability Roadmap will help guide our progress toward seamless integration of electronic health record data," said Christopher Miller, program executive officer for Defense Healthcare Management Systems within the Department of Defense.

Premier called it "a leap forward."

As Tobin sees it, the leap forward was spurred by valued-based care.

"I really believe it's because the needs created through value-based care are generating demand for a new type of information solution to help manage – and that's where this is coming from," he said. "The organization-based model in which each organization has its own EHR just doesn't fly in a value-based care world."

In his view, the roadmap is consistent with the direction ONC has  been trying to communicate over the previous six months.

"In that sense, I think it is continuing to push in the direction that they have very, very plainly said they're pushing," he said. "My guess is if they've got it even 70 percent right at this stage, we'll be lucky. But, it's the push to make it real that will allow us to get the rest of it sorted out. There's never been a focus and a push like this before."