ONC leaders see Silicon Valley-like future for EHR interoperability
Top leaders at the Office of the National Coordinator for Health IT offered a taste of what ONC’s main priorities are in the near-term and suggested where the agency is headed in the future.
“When you think about what’s left, it’s the hard stuff,” National Coordinator Donald Rucker, MD, said during a press call on Tuesday morning. “Interoperability is an extremely tough issue.”
Rucker said ONC is looking to modern computing tactics — notably open application programming interfaces that Silicon Valley companies such as Facebook and Twitter commonly deploy — to advance EHR interoperability.
The questions ONC is grappling with now, in fact, are a clear definition of interoperability, improving EMR usability and a better understanding of information blocking.
To that end, ONC is researching the best approach and that includes looking at existing and developing specifications such as FHIR or RESTful APIs such as JSON.
“There’s a lot of interest in the FHIR standard, it’s a modern API, and we’re hoping there’s coalescence around that because the large vendors have already done some work with the SMART project,” he said.
But Rucker also noted that ONC must consider the API needs of hospitals and innovators as well.
“If I’m a Silicon Valley app developer I can’t hook up to a large national EMR vendor because the data is sitting with the providers,” Rucker said.
John Fleming, MD, Deputy Assistant Secretary for Health Technology Reform said that achieving widespread interoperability will require more than just ONC and EHRs and, rather, also involves the reimbursement system.
“We’re working to improve usability and interoperability but also how we reimburse providers,” Fleming said.
That is where MACRA and the MIPs provisions specifically will be successors to the meaningful use EHR incentive program.
“The evolution is going from meaningful use to quality measures, you can see them dovetail together in MACRA,” Fleming added. “Providers are continuing to have some of the meaningful use ongoing requirements and the added quality measures. The two together, it appears to me, mean quality measurement will overtake meaningful use.”
Principal Deputy National Coordinator for Health Information Technology Genevieve Morris said that ONC will host three public meetings “meant to level-set where there’s alignment and where there’s not,” when it comes to health network-to-network data exchange. The meetings and subsequent public comments period will be used to craft a trusted exchange framework, which the 21st Century Cures Act mandates.
“We hope to have a common agreement out for public comment later this year or early next year with the final sometime next year,” Morris said.
Rucker explained that ultimately there is a broad sense in both Congress and the country that the healthcare sector can harness EHRs to become more efficient, not less so, because there is also a belief right now that EHRs are not working. And there needs to be seamless data exchange much like people experience with their smartphones — and the industry can do better by tapping into modern computer science.
“Pick the 10 apps you use the most,” Rucker added. “And ask yourself: Do I have that level of service in healthcare?”