Federal advisers share comments, concerns about draft interoperability road map

In presenting an updated version of the Office of the National Coordinator for Health IT's draft interoperability road map to a joint meeting of the federal Health IT Policy and Standards Committees on Wednesday, Erica Galvez, ONC's interoperability and exchange portfolio manager, made clear that many efforts going forward will be about balance and tradeoffs.

"We probably can't meet every need perfectly," Galvez said. "At the end of the day, interoperability is about people.

Galvez emphasized that the "device agnostic" document focuses not only on interoperability between electronic health records, but also interoperability between a number of different data sources and systems. Calling interoperability a "tremendously complex topic," she added that ONC doesn't want to be bound by a core set of use cases for fear of being stuck with guidance that doesn't meet stakeholder needs.

Galvez also stressed that the path to interoperability must be an incremental build.

"However much we wish we could wake up tomorrow and flip a switch and interoperability will just happen, this is going to be a process and it's going to be a journey," Galvez said.

Stakeholders from each committee shared comments and concerns both prior to and following Galvez's presentation. For instance, after Galvez set up an initial framework to discuss the road map--sharing with attendees a positive trend for interoperability efforts--Gayle Harrell, a member of the Florida state House of Representatives who serves on the HIT Policy Committee, took issue with ONC's statistics.

"I'm kind of a half-full glass kind of person; I believe in the positive and really knowing what's going on and always looking at the positive. However, I think we're looking at a very small glass as we're looking at what's half full," Harrell said. "When I see what is going on out there, in the reality of things, while I'm pleased that the slope is going in the right direction, your analysis [needs] more specificity on where [interoperability] is happening. Across the board, there are huge gaps in the size of practices. How many people are we truly impacting?

"That glass needs to grow."

Harrell also said that we need to know where that glass is located.

"Is it in our integrated systems? Are we having a consolidation of systems? What is happening out in the hinterland; I live in the hinterland. As a state legislator, I'm the bottom of the funnel, so I get all of the complaints and I know when it's not happening."

Marc Probst, CIO at Salt Lake City-based Intermountain Healthcare, said he felt it was important to have semantic interoperability among the healthcare community, pointing out that he was interpreting some of the data Galvez shared differently than how it was presented.

"I'm not sure we always use terms in the same way," Probst said. "I really do appreciate the trends, and I agree with you that we do have exchange occurring, [but] I believe that for this to ultimately be successful, it can't be a bunch of technology wonks sitting around a table. We need to be able to take this information and go to where the decisions get made. … We've got to move this from [information systems] into the board room, where decisions are going to get made and dollars get spent, but to do that, we've got to be clear."

Regarding privacy and security measures within the road map, Deven McGraw, a partner at Manatt, Phelps & Phillips, LLP, and chairwoman of ONC's privacy & security Tiger Team, said it was "disconcerting" that much of the focus centered on consent as a mechanism of authorization to access data.

"Without undermining the value of informed consent, I think we need to recognize that there are a lot of transactions that need to occur today that can occur assuming that the patient would consent, and that's essentially the framework that HIPAA was built on," McGraw said. "Providers shouldn't second guess whether they can send data when they're treating a patient; they should send it.

McGraw, instead, said she would like to see a focus on clarifying the policy environment for endpoints in terms of authentication and authorization.

"It should not just be about making sure that consent can accurately be passed on," McGraw said. "While that's important, we may just end up going down a rat hole if that's the only focus, because people will presume that they need it for all sorts of transactions, which could really start to gum up the machinery that we're trying to build here."

The draft road map stems from, and is a more robust version of, a vision paper published in June by ONC. The ultimate goal of ONC in developing the road map is to build a continuous learning health system.

ONC plans to publish the road map for public comment in January 2015, which will include feedback from the federal committees. By March of next year, ONC anticipates that version 1.0 of the road map will be complete.