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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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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.
Ariella
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Ariella,
User Rank: Ninja
6/6/2014 | 5:15:19 PM
Re: roadmap
@Alison Yes, there's also the possibility of a retinal scan. Once DNA reading gets more economical, perhaps a bit of hair would do the trick. 
Alison_Diana
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Alison_Diana,
User Rank: Author
6/6/2014 | 5:09:30 PM
Re: roadmap
Or if not fingerprints, then some other form of biometric? It would have to be a multi-use system to (rightfully) address the Americans with Disabilities Act, but I much prefer that approach to get another alphanumeric string. 
Ariella
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Ariella,
User Rank: Ninja
6/6/2014 | 5:03:29 PM
Re: roadmap
@Alison they probably wouldn't, but people may feel it's better not to have everything linked to their social security numbers. It's ironic how they really do become one's primary ID when they started out only to track financial information, paricularly an individual's earnings. Perhaps, though, we can try using a system that was rejected when considering an identifier back in the 30s, and opt for fingerprints. According to The Story of the Social Security Number

the Post Office Department (for Postal Savings depositors) used fingerprints for identification. However, the use of fingerprints was associated in the public mind with criminal activity, making this approach undesirable (Wyatt and Wandel 1937, 45–47). A numbering scheme was seen as the practical alternative. Thus, the employer identification number (EIN) and the SSN were created.

 


Now that computers make fingerprints easier to track and identify, not to mention that the ID is not necessarily linked to criminals, perhaps it can be used for medical IDs.

Alison_Diana
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Alison_Diana,
User Rank: Author
6/6/2014 | 4:50:23 PM
Re: roadmap
I sincerely doubt it, @Ariella! And i would question the 10-year timeline, too, based on how other deadlines have shifted within CMS and ONC (for a variety of reasons). That said, it's glaringly apparent that interoperability is crucial. I'm not sure whether the decision to create another ID number -- a healthcare ID number -- is the way to go. We already have social security numbers and can't keep them safe. Who's to say health ID numbers would be any more secure?
Ariella
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Ariella,
User Rank: Ninja
6/6/2014 | 4:47:06 PM
roadmap
It definitely makes sense to get everyone on the same page in terms of interoperability. My guess is that the road to that end will not be altogether smooth.
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