A Shared Nationwide Interoperability Roadmap: A Focus on the Vision Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN Vice President, Informatics HIMSS Robert Cothren, PhD Executive Director, California Association of Health Information Exchange (CAHIE)
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A Shared Nationwide Interoperability Roadmap: A Focus on the Vision
Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN Vice President, Informatics HIMSS Robert Cothren, PhD Executive Director, California Association of Health Information Exchange (CAHIE)
• Discuss the over-arching vision of creating an interoperability roadmap;
• Review the drivers, policies, and technical components of the Nationwide Interoperability Roadmap;
• Discuss the Standards Advisory model and the role to be used in leveraging standards.
Today’s Learning Objectives:
• A learning health system where individuals are at the center of their care
• Where providers have a seamless ability to securely access and use health information from different sources
• Where an individual’s health information is not limited to what is stored in electronic health records (EHRs), but includes a longitudinal picture of their health
What’s the Vision for the Roadmap?
“…the ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user.”
How interoperability is defined within the Roadmap...
ONC Milestones from 2014-2015:
1. ONC released their 10-Year Vision Paper in June, 2014 2. ONC Released the Draft Federal Health IT Strategic Plan 2015-2020
in December, 2014 3. ONC released the Draft Interoperability Roadmap and the
Interoperability Standards Advisory in January, 2015 4. ONC released the Final Version of the Federal Health IT Strategic
Plan 2015-2020 in September, 2015 5. ONC released the Final Version 1.0 of the Interoperability Roadmap
in October, 2015. Will be updated every two years.
6. ONC will release the latest Interoperability Standards Advisory in December, 2015 for the 2016 calendar year
Shared Roadmap - Version 1.0 Overview of the Process and Timeline
Initial roadmap development
FACA review and recommendations
Roadmap released for public comment
Nationwide Interoperability Roadmap Version 1.0
Q3/Q4 2015
Shared Roadmap - Version 1.0 Vehicles for Stakeholder Feedback
7
• 2015-2017: Send, receive, find and use priority data domains to improve health care quality and outcomes.
• 2018-2020: Expand data sources and users in the interoperable health IT ecosystem to improve health and lower costs.
• 2021-2024: Achieve nationwide interoperability to enable a learning health system, with the person at the center of a system that can continuously improve care, public health, and science through real-time data access.
The Roadmap Goals & Timeline
Goal 4 Enhance Nation’s Health IT Infrastructure
The Roadmap’s implementation is a critical part of the Federal Health IT Strategic Plan 2015-2020.
Alignment with Federal Health IT Strategic Plan
• Focus on value.
• Be person-centered.
• Protect privacy and security in all aspects of interoperability and respect individual preferences.
• Build a culture of electronic access and use.
• Encourage innovation and competition.
ONC’s Guiding Principles for Nationwide Interoperability
• Build upon the existing health IT infrastructure.
• One size does not fit all.
• Simplify.
• Maintain modularity.
• Consider the current environment and support multiple levels of advancement.
• All individuals, their families and health care providers should be able to send, receive, find and use electronic health information in a manner that is appropriate, secure, timely and reliable to support the health and wellness of individuals through informed shared decision-making.
• A learning health system is an ecosystem where all stakeholders can securely effectively and efficiently contribute, share and analyze data.
Interoperability Vision for the Future
Four Critical Pathways Identified 1. Improve technical standards and implementation guidance for
priority data domains and associated elements. In the near-term, the Roadmap focuses on using commonly available standards, while pushing for greater implementation consistency and innovation associated with new standards and technology approaches, such as the use of APIs.
2. Rapidly shift and align federal, state, and commercial payment policies from fee-for-service to value-based models to stimulate the demand for interoperability.
3. Clarify and align federal and state privacy and security requirements that enable interoperability.
4. Align and promote the use of consistent policies and business practices that support interoperability and address those that impede interoperability, in coordination with stakeholders.
• In this final version, ONC moved away from the five buildings blocks they proposed in their Draft Version from January 2015 and instead built this final version of the Roadmap around three main sections:
1. Drivers – incentives that promote interoperability
2. Policy and Technical Components – must be implemented to achieve interoperability
3. Outcomes – should be met and measured
Key Changes from the Draft to Final Interoperability Roadmap
1. Drivers
2. Policy and Technical Components
3. Outcomes
Three Sections to the Roadmap
• Supportive Payment and Regulatory Environment – Rapidly shift and align federal, state, and
commercial payment policies from fee-for-service to value-based models to stimulate the demand for interoperability.
• Milestones
• Call to Actions
• Commitments
1. Drivers
• Consistent Data Semantics – As electronic health information is shared and used
among different stakeholders, its meaning must be consistently maintained in order to maximize its usage and value in a learning health system.
• Milestones
• Call to Actions
• Commitments
2. Policy and Technical Components
• Consistent Data Formats – Consistently representing electronic health
information across different stakeholders and systems is the bedrock of successful interoperability. In a learning health system, while user interfaces can and should be different depending on the user, the format in which electronic health information is shared between health IT systems must be consistent and machine readable, so that the meaning and integrity of information is retained as a variety of users interact with it.
2. Policy and Technical Components
• Consistent, Secure Transport Techniques – Interoperability requires transport techniques that
are non-proprietary, easy to configure and widely and consistently used. The fewest number of protocols necessary to fulfill the needs of learning health system participants is most desirable.
2. Policy and Technical Components
• Secure, Standard Services – Services should be modular, secure and standards-
based wherever possible.
2. Policy and Technical Components
• Industry-wide Testing & Certification Infrastructure – A variety of health IT testing tools and resources
must be broadly available to stakeholders to support technology from development through deployment. Testing and certification programs must provide health IT users with reasonable assurance that health IT is interoperable.
2. Policy and Technical Components
• Accurate Individual Data Matching – Whether aggregated in a repository or linked "just in
time," electronic health information from disparate sources must be accurately matched to prevent information fragmentation and the incorrect merging of records. As technology evolves, provider identities, system identities, device identities and others that support public health and clinical research will need to be accurately matched.
2. Policy and Technical Components
• Health Care Directories and Resource Location – The ability to rapidly locate resources, including
providers, individuals, APIs, networks, etc. by their current or historical names and descriptions will be necessary for finding, accessing and/or sharing electronic health information.
2. Policy and Technical Components
• Ubiquitous, Secure Network Infrastructure – Enabling an interoperable, learning health system
requires a stable, trusted, secure, widely available network capability that supports technology developer-neutral protocols and a wide variety of core services.
2. Policy and Technical Components
• Verifiable Identity & Authentication of All Participants
– Legal requirements and cultural norms dictate that users of systems—whether people or machines—be known so that access to data and services is appropriate. This is a requirement for all participants in nationwide interoperability that supports a learning health system regardless of their role (e.g., individual, patient, provider and administrator).
2. Policy and Technical Components
• Consistent Representation of Authorization to Access Electronic Health Information
– When coupled with identity verification, this allows consistent decisions to be made by systems about access to information.
2. Policy and Technical Components
• Consistent Understanding and Technical Representation of Permission to Collect, Share and Use Identifiable Electronic Health Information
– Though requirements differ across states, nationwide interoperability requires a consistent way to represent legal permission to collect, share and use individually identifiable electronic health information, including with whom and for what purposes.
2. Policy and Technical Components
• Shared Decision-Making, Rules of Engagement and Accountability
– Nationwide interoperability across the diverse health IT ecosystem will require stakeholders to agree to and follow a common set of standards, services, policies and practices that facilitate the appropriate exchange and use of health information nationwide and do not limit competition. Maintaining interoperability once established will also require ongoing coordination and collaborative decision-making about future change.
2. Policy and Technical Components
• Individuals
– Individuals have access to longitudinal electronic health information, can contribute to that information, and can direct it to any electronic location.
• Milestones
• Call to Actions
• Commitments
3. Outcomes
• Tracking Progress and Measuring Success – Measuring nationwide interoperability directly
informs our national progress toward achieving better care, smarter spending and healthier people and ultimately a learning health system.
3. Outcomes
• Providers
– Provider workflows and practices include consistent sharing and use of patient information from all available and relevant sources.
3. Outcomes
What is it? A non-regulatory, straight-forward approach with an interactive, predictable process for updates to identify, assess and determine the “best available” interoperability standards, profiles and implementation specifications for industry use to fulfill specific clinical health IT interoperability needs.
Overall goal: - A widely vetted resource that is in one place without regulation and
designed to create a common ground.
- Enable a “look first” philosophy for government programs, procurements, testing or certification programs, standards development, etc.
- Revised on a calendar year basis
Understanding the 2016 Interoperability Standards Advisory
Standards Advisory Review Process and Key Dates
Month Actions December
Preceding the Upcoming
Calendar Year
• The new Interoperability Standards Advisory for the next calendar year is published (e.g., December 2016 for the 2017 Advisory).
• A first round of an approximately 90- to 120-days of public comment period will be opened on that year’s Interoperability Standards Advisory.
April/May • Sometime during late April/early May the comment period will expire. • ONC staff will compile all comments received during the first round comment
period. • ONC staff will present a summary of received comments to the HIT
Standards Committee (or designated Task Force) in order to prepare them to make recommendations on updates for the following year’s Interoperability Standards Advisory.
August • The HIT Standards Committee submits recommendations to the National Coordinator concerning updates to the following year’s Interoperability Standards Advisory.
• A second round of approximately 60-days of public comment will be opened on the HIT Standards Committee’s recommendations concerning the Interoperability Standards Advisory.
Standards Advisory Review Process and Key Dates Month Actions
October – December
• Sometime during October the comment period will expire. • ONC will review the HIT Standards Committee recommendations as well
as public comments on those recommendations. • ONC will prepare the next year’s Interoperability Standards Advisory for
publication.
Important to note!
• If a standard or implementation is under development and expected to be completed during this process, it could be considered for inclusion in the next year’s Interoperability Standards Advisory.
• Changed “Purpose” to “Interoperability Need”
• Added “Emerging” row for standards and implementation specifications
• Removed the “Transport” Section
• Inserted Appendix that contains “Sources for Security Standards”
• Added six “informative characteristics” for each standard and implementation specification
• Added additional context structure
• Revision history
What Changed from 2015 to 2016?
Example from 2016 Standards Advisory II-O: Summary care record Interoperability Need: Support a transition of care or referral to another provider
Important Resources Resource Title Source Location A Shared Nationwide Interoperability Roadmap version 1.0
ONC https://www.healthit.gov/policy-researchers-implementers/interoperability
Draft 2016 Interoperability Standards Advisory
ONC https://www.healthit.gov/standards-advisory/2016
Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure
ONC https://www.healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf
Interoperability Roadmaps: A Compare and Contrast Summary
HIMSS http://s3.amazonaws.com/rdcms-himss/files/production/public/FileDownloads/Interoperability%20Roadmaps%20-%20Compare%20and%20Contrast%20Summary_FINAL.pdf
HIMSS 2015 Standards Advisory Comments
HIMSS http://www.himss.org/News/NewsDetail.aspx?ItemNumber=41980
HIMSS Comments on the Draft Interoperability Roadmap
HIMSS http://www.himss.org/News/NewsDetail.aspx?ItemNumber=41245
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