The ambitious 166-page draft document published by the Office of the National Coordinator for Health IT this past week lays out the "critical actions that the public and private sector need to take" toward real and robust nationwide data sharing. Here are some of the high points.
The Nationwide Interoperability Roadmap identifies the 10 basic principles of data sharing, and spotlights the short- and long-term actions for all stakeholders should work towards in the coming decade to get there. ONC's vision "significantly expands the types of information, information sources and information users well beyond clinical information derived from electronic health records."
From governance to standards, policymakers to providers, the roadmap lays out specific benchmarks to be met between now and 2020.
The roadmap is meant to work in tandem with the draft Federal Health IT Strategic Plan 2015-2020, which describes a set of data-driven goals that align with the so-called Triple Aim: improving healthcare quality, lowering costs and improving the health of populations.
ONC describes a learning health system as one characterized by continuous cycles, at many levels of scale and with a broad array of stakeholders. "For example, a learning health system includes transactions for routine and emergency public health services among governmental agencies (e.g., state and local health departments, emergency responders and public safety); hospitals; health care professionals; diagnostic laboratories; researchers; and non-governmental social services, advocacy and community based organizations," according to the roadmap. "It also incorporates advanced health models that increasingly leverage technology, such as telecommunications technology to deliver health and clinical services remotely, that improve access to care across clinical and non-clinical community settings."
"A learning health system includes the broad range of people and organizations traditionally involved in the delivery of clinical care (providers, individuals, payers) and many outside the care delivery system who impact the health of individuals (e.g., community-based social and human service organizations, schools, the research community, etc.)," according to ONC.
"In most cases, individuals, groups and organizations fit more than one stakeholder perspective," the interoperability roadmap points out. "Furthermore, professional organizations that represent the interests of a particular stakeholder may identify with one or more stakeholder perspective."
Data exchange governance "should address three main subject matter areas: policy, operations and technical standards," according to ONC. "There needs to be a single set of basic rules of the road to support interoperability nationwide and address consumer protection."
"It is essential to maintain public trust that health information is safe and secure," the report emphasizes. "To better establish and maintain that trust, we will strive to ensure that appropriate, strong and effective safeguards for electronic health information are in place as interoperability increases across the industry."
"Data holders and entities facilitating exchange of electronic health information should ensure standards are prioritized, developed and implemented to support the public interest, national priorities and the rights of individuals (e.g., health care delivery, privacy)," according to the report. "Standards should support data portability from one health IT product to another. The development and implementation of technical requirements should enable the adaptation and incremental evolution of health information exchange and technologies supporting exchange to meet current and future needs of users as standards evolve."
The ONC roadmap identifies key areas that require ongoing measurement. "There are three key domains: the adoption of technology and policy enablers that increase the capability to exchange in an interoperable manner; information flow and usage of interoperable information; and, impacts of exchange and interoperability on improved health
and healthcare and the cost of that care."
These are the overarching goals and objectives for establishing and expanding an interoperable health IT infrastructure over the coming decade. ONC sets benchmarks to meet in the next three, six and 10 years.
In the meantime, the report expects real and achievable progress on specific measures of data exchange, this year and next.
A bit further down the road, ONC foresees much bigger strides in infrastructure build-out and information exchange activity.
The report identifies a number of measurement gaps; to address them, it calls for the types of data sources used to report on interoperability progress to be broadened. "ONC presently is largely reliant on self-reported data from national surveys and program participants," according to the roadmap. "In particular, there is limited information available from key entities that enable exchange and interoperability, such as health information organizations, HISPs and health IT developers."