Health IT Interoperability Up To Market, Say Feds

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The co-chairs of the federal Health IT Policy Committee's Jason Task Force (JTF) are advocating a mix of mostly market-led initiatives and some government action to spur adoption of open standards for electronic health information sharing in the US.

In comments to InformationWeek on Monday, David McCallie and Micky Tripathi of the JTF both recommended an approach where healthcare providers and vendors of healthcare systems take the lead in addressing technology interoperability issues, with the government intervening where necessary.

The Jason Task Force, an ad-hoc working group of the Health IT Policy Committee, was established to review the findings of a federally commissioned study conducted last year on the requirements for an electronic health data infrastructure in the US.

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McCallie, director of the Cerner Medical Informatics Institute, and Tripathi, president of the Massachusetts eHealth Collaborative, released a set of recommendations last week for the healthcare industry based on their review of that study.

One of their biggest recommendations is the immediate need within the health industry for standard, public application programming interfaces that allow disparate health systems to speak with one another. Such APIs are critical to enabling the interoperability required for electronic health information exchanges.

"We believe that a standards-based API, combined with appropriate incentives to encourage vendors to implement the API and providers to enable access to their data via the API has potential to move interoperability forward dramatically," McCallie said in emailed comments.

Because healthcare is such a large and complex industry, many stakeholders will need to come together to figure out a way to develop and adopt a public API, he said.

"The JTF called for a mixed approach that leverages market forces, but uses government 'levers,' such as certification, to help ensure that the market works effectively," McCallie said. Better measurements of actual interoperability and greater transparency around those measurements will help foster adoption.

The JTF's calls for a public API and industry collaboration come amid growing concerns about technology interoperability issues bogging down efforts to build an infrastructure for electronically sharing patient medical data in the US.

This month, the Office of the National Coordinator for Health Information Technology (ONC) released a report to Congress warning of the current lack of standards for Electronic Health Records (EHR) systems. Interoperability issues are "a major impediment to the unencumbered exchange of health information and the development of a robust health data infrastructure," the ONC said in calling for standard approaches for health information sharing.

Tripathi said a public interface that allows healthcare applications and systems to talk securely with one another is critical. Any public API developed for the healthcare industry should enable data and document-level access to clinical and financial systems while ensuring adequate security and privacy protections.

It is not yet clear who exactly should take the lead in developing a public API for the healthcare industry. But the bias is toward the market taking a greater share of the responsibility, Tripathi said. Vendors and healthcare providers are in a better position to identify gaps and functional requirements for interoperability and therefore should be encouraged to find a way to address them, he said.

The ONC and the Centers for Medicare & Medicaid Services (CMS) should immediately contract with a standards development organization or an active industry consortium to accelerate development of initial APIs focused on high-value use cases to get the ball rolling, he said.

The government's role should also be to guide the process along and to implement nonregulatory measures to catalyze adoption of the APIs, Tripathi said.

One way to do this would be to tie federal incentives for meaningful use of EHRs more closely to interoperability. The focus should be more on measuring outcomes that are related to interoperability than on the overly broad and often vague metrics that are used to reward providers for meaningful use currently, Tripathi said.

Similarly, McCallie said, the government could encourage vendors to implement the public API in their products by implementing a certification process.

"Once a public API certification test is available, various government incentive programs can then add the public API to their set of required certification," McCallie said. "Vendors will see the value of becoming certified for the public API and will react accordingly. We believe that this is an appropriate way to leverage the government's regulatory power."

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