ONC advisers pinpoint HIE problems

The governance subgroup of the federal government's Health IT Policy Committee this week pinpointed problems in the health information exchange ecosystem based on several factors, including severity and commonness, the impact on private and secure exchange and the Office of the National Coordinator for Health IT's ability to solve such problems.

Among the top issues causing negative impacts on HIE quantity, the group identified an inconsistency in laws for sharing protected health information, varying approaches to DirectTrust accreditation and varying patient matching standards among providers and other data intermediaries.

Key issues impacting the private and secure exchange of electronic health information included inconsistent encryption efforts for data in motion and the ability to determine the status of a data requester as it pertains to treatment of a patient.

Five problems the group said it thinks would benefit from new governance, policies, programs or recommendations from ONC included:

  1. Inconsistent identification proofing practices for data users
  2. Varying patient matching standards and methods
  3. Varying approaches for how data holders should respond to queries
  4. No minimum standard of authentication practices for access to electronic data
  5. Too many trust bundles tied to differing trust/security policies

At a prior meeting on Aug. 15, provider and vendor representatives in the subgroup discussed looming interoperability issues from technological, business and governance vantage points. Carl Dvorak, president of Verona, Wisconsin-based EHR vendor Epic, said that at least one factor limiting health data exchange is HIEs forcing participants to pay full fees for individual services, such as access to public health and immunization registries.

Dvorak also called for the creation of a national phone book of exchange-ready providers, simple and affordable trust validation service and straightforward "rules of the road" to improve interoperability.

ONC is in the process of crafting an interoperability roadmap, which stems from ideas shared in a vision paper published in June. A draft of the roadmap is due in October, while a more robust version that includes feedback from ONC's health IT policy and standards committees will be available for public comment by January 2015.

Version 1.0 of the roadmap, which officials say will be a "living document," is anticipated to be ready by March 2015.

To learn more:
- listen to the Aug. 26 meeting
- download the accompanying slides

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