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From Health Law Daily, January 30, 2015

Long awaited roadmap for health IT odyssey unveiled by the ONC

By Danielle H. Capilla, J.D.

A draft roadmap proposing crucial actions for public and private stakeholders to advance an interoperable health information technology (IT) ecosystem, advance research, and achieve a learning health system has been released by the Office of the National Coordinator for Health IT (ONC). The roadmap, titled “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0” is part of the ONC’s mission of advancing health IT interoperability in order to positively transform health care delivery systems. A learning health system is defined as an environment that links to the care delivery system with communities and societal supports in “closed loops” of electronic health information flow, at many levels, to enable continuous learning and improved health.

The roadmap provides three critical pathways of: (1) requiring standards; (2) motivating the use of those standards through appropriate incentives; and (3) creating a trusted environment for the collecting, sharing and using of electronic health information. The ONC is currently accepting public comments and key commitments on the roadmap through April 3, 2015. The roadmap includes a variety of questions for the public to consider when responding during the comment period, on topics such as priority use cases, governance, and core technical standards and functions.

ONC’s roadmap piggybacks on an earlier version it released in June of 2014 titled “Connecting Health and Care for the Nation: A 10-Year Vision to Achieve Interoperable Health IT Infrastructure (ONC’s 10-Year Interoperability Concept Paper)” in which the ONC committed to leading and collaborating with the health IT and health sector to achieve interoperability by 2024.

Accompanying the roadmap was a letter from the National Coordinator, Karen B. DeSalvo, MD, MPH, MSc, stating that the draft roadmap proposed critical actions that the public and private sector need to take to advance an interoperable health IT ecosystem over the next 10 years, which in turn advances Secretary Burwell’s “vision of better care through smarter spending, leading to healthier people.” The roadmap aligns with the Federal Health IT Strategic Plan 2015-2020.

Three, Six, 10 year plans. The June 2014 concept paper outlined a three, six, and 10 year agenda, which the roadmap seeks to provide actions and roles to achieve. The three year agenda is to send, receive, find, and use health information to improve health care quality.

The ONC’s six year plan realizes enhanced interoperability, for instance the ability for care providers in schools, ambulances, and prisons, to appropriately exchange and use relevant health information. The ONC envisions remote monitoring being enabled between medical devices, home-monitoring tools, and health information technology. It also includes multi-payer claims databases, clinical data registries, and other data aggregators becoming more integrated.

In 10 years, the ONC plans to have a national health IT infrastructure that will support better health through a more connected health care system and active individual health management. The plan involves an evolution of standards, policies, and data infrastructure. It envisions health IT systems that enable analysis of aggregated data and the use of local data at points of care though targeted clinical decision support, as well as accelerated and automated clinical trial recruitment, data collection, and analysis. The new roadmap describes barriers to interoperability across the current landscape, as well as paths to achieving the goals in each time frame.

Ecosystem. The roadmap lays out an interoperable health IT ecosystem with the following principles:

  • Building upon existing health IT infrastructure;

  • maintain modularity;

  • one size does not fit all;

  • consider the current environment and support multiple levels of advancement;

  • empower individuals;

  • simplify;

  • protect privacy and security in all aspects of interoperability;

  • leverage the market

  • focus on value; and

  • scalability and universal access.

Near term wins. The roadmap provides four items for immediate action in the near term: (1) establish a coordinated governance framework and process for nationwide health IT interoperability; (2) improve technical standards and implementation guidance for sharing and using a common clinical data set; (3) enhance incentives for sharing electronic health information according to common technical standards, starting with a common clinical data set; and (4) clarify privacy and security requirements that enable interoperability.

Building blocks. The roadmap is based on a core set of business and functional requirements to achieve a learning health system, and the core requirements are organized by five building blocks. They are: (1) rules of engagement and governance; (2) supportive business, clinical, cultural and regulatory environments; (3) privacy and security protections for health information; (4) certification and testing to support adoption and optimization of health IT products and services; and (5) core technical standards and functions.

Success. The roadmap provides key domains in the measurement and evaluation framework for tracking progress in health IT interoperability. The ONC notes that many changes will be measured in the long-term. The ONC will be looking at the capability to exchange information in an interoperable manner, information flow and usage, as well as the overall impacts, when it determines success.

MainStory: TopStory HITNews EHRNews

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