Health industry groups expressed optimism following the Oct. 15 meeting of the federal government's Health IT Policy and Standards committees to discuss a draft interoperability road map unveiled by the Office of the National Coordinator for Health IT.
In particular, the College of Healthcare Information Management Executives and Health Level Seven International (HL7) viewed the road map as a step in the right direction. CHIME Director of Federal Relations Jeff Smith (pictured right), who was critical of the interoperability vision paper published in June from which the draft road map stems, told FierceHealthIT that the updated document represents a "marked improvement" from its predecessor.
"The vision paper was very short on details and wasn't at all clear as to what the next version of things would look like," Smith said in a phone conversation. "Based on what we saw yesterday and based on the conversations that were had at the policy committee, things bode well for the next phase and it sounds like ONC is taking diligence in trying to put together something that is both technically robust, as well as considerate of various policies that fall outside the purview of technical standards."
Smith said CHIME will pay close attention to the governance piece of the road map, calling ONC's recommendations neither good nor bad.
"It seems that ONC believes that governance will be the key to putting forth a lot of what will be final recommendations and ultimately final policies," Smith said. "I'm reserving judgment as to whether or not a focus on a governance mechanism is going to be a good thing or a bad thing, but I think that a lot of it will come down to 'is the governance process mechanism easily understood?'"
To that end, Smith said he was "having flashbacks" to the request for information on governance of the Nationwide Health Information Network (NwHIN), which was issued in May 2012. ONC ultimately tabled discussion of NwHIN governance in September 2012.
"I was told a lot of the policies put forth in the NwHIN RFI were remnants of discussions that were had in the late 2000s," Smith said. "It'll be interesting to see what kinds of policies are put forth to construct the kind of governance that was discussed yesterday."
HL7 CEO Charles Jaffe (pictured left) called ONC's efforts "valiant" in a phone conversation with FierceHealthIT.
"I think it's very ambitious," Jaffe said. "There were lots of important points made. I think there's natural tension between trying to be innovative and trying to be prescriptive. I don't think they always go hand-in-glove."
Additionally, both Smith and Jaffe said they agreed with recommendations made by the JASON task force that Stage 3 should be used as a "pivot point" to initiate the transition to public application programming interfaces (APIs) and that current interoperability approaches are limited and need to be eventually replaced by more comprehensive API-based architecture.
The task force also suggested that ONC consider delaying or staggering Stage 3 incentives to accommodate the accelerated development process for public API specifications.
"It would have been critical to reference the cutting-edge technologies that JASON had identified, particularly FHIR [Fast Healthcare Interoperability Resources], to be successful" in Stage 3, Jaffe said. "The fact is, that the marketplace will decide if the electronic health record vendors incorporate FHIR into their products, and if providers request or demand it, then we'll have de-facto adoption regardless of whether it's in regulation."
Smith said that without knowing whether FHIR or public APIs will be the panacea of interoperability, they represent a "fresh approach" to a problem that has persisted for too long in healthcare.
"I'm optimistic that the JASON task force recommendation can start to get us closer to those answers," he said.
Smith, however, did express disappointment in what he called a "disconnect" between the process of developing, testing and implementing technology in healthcare and the government timelines driving the process.
"There was a very light recommendation put forth by the JASON task force regarding Stage 3 and incentives and timing, and what's frustrating is that we really have one more shot at getting the industry getting the industry to get more aligned," Smith said. "The policy committee put forth Stage 3 recommendations last spring, as did the standards committee, and yet, here we are, six months after the fact, still making recommendations. I think that's good, but it represents a fundamental disconnect of how pieces have to fit."
Smith added that he and CHIME are under the impression that the notice of proposed rulemaking for Stage 3 could come out at any point over the next two to three months.
"We understand that Stage 3 is going through clearance, decisions have been made, and we're moving forward," he said. "It seems to be a little disjointed in terms of the process of building toward Stage 3 vs. the process of trying to make the appropriate advancements in standards and in policy."