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6/6/2014
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ONC Releases Healthcare Interoperability Roadmap

The Office of the National Coordinator of Health IT outlines an ambitious plan to link patients' health records across the entire medical ecosystem.

Technology Declares War On Cancer
Technology Declares War On Cancer
(Click image for larger view and slideshow.)

The Office of the National Coordinator (ONC) for Health Information Technology (HIT) released an aggressive 10-year plan Thursday to create an interoperable network of databases that support information sharing and aggregation for patients, providers, researchers, and government.

The ONC's move is designed to reduce costs, improve population health and patient engagement, and give patients more access to and control over their data, according to its concept paper. Extending beyond healthcare facilities, this integrated health ecosystem will reward value, not volume, of care, according to the department -- a move seen as vital to the industry's evolution away from its fee-structured system.

[Switching from fee-for-service to value-based reimbursement is no easy task. See Healthcare's Big Challenge: How To Measure Value.]

Karen DeSalvo envisions an interoperableworld of healthcare.
Karen DeSalvo envisions an interoperable
world of healthcare.

This framework is consistent with recent public comments by Dr. Karen DeSalvo, National Coordinator for Health IT, including an April blog post and a May keynote presentation, in which she discussed the benefits of an interoperable healthcare system.

Industry organizations praised the framework.

"We... believe that it will be helpful for the industry to have a common understanding of what to expect as we look 10 years ahead regarding interoperability," Devin Jopp, president and CEO at the Workgroup for Electronic Data Interchange (WEDI), said in an interview. "Overall, the vision seems directionally consistent with the 2013 WEDI Report, which was issued in December of last year with the support of [then] Secretary [Kathleen] Sebelius. The 2013 WEDI Report laid out a vision for healthcare information exchange -- in order to get the right information, to the right place, at the right time."

Likewise, Health IT Now came out in support of the ONC charter. "HITN has advocated for more robust interoperability since the Coalition began in 2007, so we applaud ONC's vision to achieve greater interoperability between now and 2024," Joel White, the organization's executive director, wrote on its website. "Interoperability is a precursor to transformation that lowers health costs, and that improves health outcomes, quality, and safety."

The ONC said the nation will achieve interoperability by focusing on five building blocks:

  1. Core technical standards and functions
  2. Certification in support of optimization and adoption of HIT products and services
  3. Privacy and security
  4. Supportive business, clinical, cultural, and regulatory environments
  5. Rules of engagement and governance

However, WEDI's Jopp said the ONC must go further. The government should adopt a standardized patient identification process across healthcare. In addition, government can do more -- perhaps in partnership with organizations such as the Louis W. Sullivan Institute for Healthcare Innovation -- to improve consumer literacy and help individuals use new healthcare technologies.

"The ONC vision, in discussing new payment models, does not discuss the need for closer integration between both clinical and administrative data," he said. "The 2013 WEDI Report recommended that the industry identify methods and standards for harmonizing clinical and administrative information reporting that would reduce data collection burden, support clinical quality improvement, contribute to public and population health, and accommodate new payment models. This closer integration is critical in order to effectively reach fee-for-value arrangements, which will require a much more complex level of quality and payment data integration."

Download Healthcare IT In The Obamacare Era, the InformationWeek Healthcare digital issue on changes driven by regulation. Modern technology created the opportunity to restructure the healthcare industry around accountable care organizations, but ACOs also put new demands on IT.

Alison Diana has written about technology and business for more than 20 years. She was editor, contributors, at Internet Evolution; editor-in-chief of 21st Century IT; and managing editor, sections, at CRN. She has also written for eWeek, Baseline Magazine, Redmond Channel ... View Full Bio

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Alison_Diana
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Alison_Diana,
User Rank: Author
6/12/2014 | 9:17:23 AM
Re: Where's the health IT industry consolidation roadmap?
Yes, I agree with you @David about the market naturally shaping EMRs. And I believe incentive programs and the government mandate distorted and created an unnatural market for EMRs, courtesy of MU et al. That said, it's hard to argue that healthcare organizations would have adopted tech without any government action (or interference, as some say). One problem with 'artificial deadlines' is, as we're now seeing, some organizations simply automated manual processes; they didn't use this investment as an opportunity to review, reconsider, and redesign inefficient procedures and create new and better workflows that leverage the full power of automated systems. So you basically have software doing what people have done for decades -- not always the best use of tech or skilled professionals' time. 
David F. Carr
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David F. Carr,
User Rank: Author
6/11/2014 | 7:52:56 PM
Re: Where's the health IT industry consolidation roadmap?
The market, not the government. The question is whether the MU program has distorted the shape of the market.
Alison_Diana
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Alison_Diana,
User Rank: Author
6/11/2014 | 9:27:52 AM
Re: Where's the health IT industry consolidation roadmap?
By "culling the market for health products," do you mean have the government decide which EHRs stay or go, @David? I won't address that point until I'm clearer on the meaning! :)

As to interoperability, while I may be naive here (although after covering tech for 20+ years, it's hard to imagine!), plenty of other industries have accomplished this goal. It may not have been easy. It may not have been painless. But they finally arrived at the point where different vendors' products are interoperable. Customers demanded the capability -- and vendors were forced to comply. Government mandates created an artificial market, where providers were forced to rush into EHR purchases within a prescribed time, creating a fake bubble that allowed EHR vendors to meet only government requirements (eg, MU 1, then 2). Since interoperability was not part of that mandate, they were able to coast on this. And who can blame them. 

From providers' POV, many were scrambling to meet government deadlines and focused only on mandate requirements. If a vendor met those needs, then it could be in the list of candidates. Interoperability did not (always) come into it. Of course, now healthcare providers are living with the results -- and we are seeing many switching to alternative providers, sometimes for that reason.

 
David F. Carr
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David F. Carr,
User Rank: Author
6/10/2014 | 5:43:20 PM
Where's the health IT industry consolidation roadmap?
I have to wonder whether the interoperability problem isn't a factor of too many health IT vendors, sustained by government subsidies. Culling the market for health IT products might be the best thing for interoperability. Standards are nice, but it's really hard to make standards so standard that they work without tweaking across a large number of vendors for a wide range of uses. When there are so many different EHRs in use, it's difficult for every vendor to churn out compatibility tweaks for every other vendor -- and we wind up with patchwork, partial interoperability.

True? Or have I been spending too much time talking with Jonathan Bush?
Ariella
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Ariella,
User Rank: Ninja
6/9/2014 | 11:48:47 AM
Re: roadmap
@Alison thanks for clarifying. That's what I thought. 
Alison_Diana
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Alison_Diana,
User Rank: Author
6/9/2014 | 10:32:24 AM
Re: roadmap
From what I've heard, there are no more financial "carrots" coming to practioners from the government. Now, when it comes to government handing out money, I'd say never say never! It is going to be extremely difficult to change behavior and incentives are certainly one way of encouraging behavior changes. Penalties are the opposite form, and government has used both these forms in healthcare (and other industries) in the past.
Alison_Diana
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Alison_Diana,
User Rank: Author
6/9/2014 | 10:29:42 AM
Re: roadmap
Yes: There are financial penalties for HIPAA breaches that affect more than 500 patient records. The government has been penalizing organizations of all sizes which should, I'd imagine, sound a more chilling note to healthcare organizations that they must take HIPAA seriously. I know service providers like HIPAASecureNow have told me more practices are seeking risk assessment services.
Gary_EL
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Gary_EL,
User Rank: Ninja
6/8/2014 | 12:31:34 PM
Re: roadmap
Right, but not yet. After all, there are no standards as yet to adhere to. I don't imagine "the stick" will be much of a factor. Once it gets up and running, staying out will turn out to be it's own penalty in many ways.
Ariella
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Ariella,
User Rank: Ninja
6/8/2014 | 9:57:28 AM
Re: roadmap
@Gary_EL so you would use both carrots and sticks? There were programs that offered medical practioners and facilities financial incentives for getting on board with EHR systems, but I don't think there were any penalties for not doing so. Of course, that doesn't mean it is unheard of. I believe HIPPA is enforced with the threat of penalties. 
Gary_EL
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Gary_EL,
User Rank: Ninja
6/7/2014 | 9:04:37 PM
Re: roadmap
There used to be a term called "Islands of Automation". I live in one myself, in that every facility within the hospital network that I get my health care in uses the same interconnected computer system. Every clinician I see has instant access to what every other one has done or prescribed. The data also goes to both their financial offices to my insurance company. The prescription's go right to my participating pharmacist. About all I have to is to pay my bills.

The hard part about doing something like this nationally would be coming up with standards that would be fair to all the players and their needs. Once the serious discussions have drawn a critical mass of insurance companies and hospitals, it would be time for the federal government to come on board. Financial incentives would be put in place for cooperation, and gradual financial penalties could be established for not.
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