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Catalyst Corner: September/October 2014

In anticipation of releasing a “refreshed” health information technology (HIT) strategic plan later this year, the Office of the National Coordinator for Health Information Technology (ONC) is seeking comment on a 10-year vision for achieving an interoperable HIT infrastructure that it released in June. It is not lost on this writer that it has already been 10 years since ONC was formed and the first strategic plan to achieve HIT interoperability was created. The new report, available as a PDF at www.healthit.gov, acknowledges that “dramatic” progress has been made in the last decade to build a nationwide foundation that is “resilient” and “flexible” enough to accommodate change. It goes on to say, however, that “there is much work to do to see that every individual and their care providers can get the health information they need” electronically “when and how they need it to make care convenient and well- coordinated.” The official report title is, “Connecting Health and Care for the Nation: A 10-year Vision to Achieve an Interoperable Health IT Infrastructure.”

ONC is seeking as much input as possible on how to make true interoperability happen, according to National Coordinator Karen DeSalvo. Prior to releasing the strategic plan for comment later this year, ONC has set up a Wiki for feedback on the priorities they should set based on the vision report. The Wiki can be accessed readily at www.healthit.gov. Look for the “Nationwide Interoperability Roadmap Community,” where comments can be submitted on ONC’s three-, six-, and 10-year interoperability milestones.

DeSalvo has indicated there may be places where the private sector will have better solutions for advancement than the federal government. “That is an opportunity for the little folks that think they don’t have a voice to have a chance to weigh in,” she said at the eHealth Initiative 2020 Road- map Executive Summit in Washington, D.C., on Sept. 4.  

She also said during her conversation with Sam Ho, United Healthcare executive director and eHI’s board chair, that “this country is impatient,” and no one wants to wait that long in response to the 10-year vision report. She added, though, that it’s important to think long term, and get the governance and privacy and security standards right. A full transcript of her conversation may be accessed at assets.fiercemarkets.com.

ONC Priorities

In the report, ONC notes the goal is to develop an interoperable health IT ecosystem that can simultaneously improve population health, boost patient engagement, and lower costs. It states that “By 2024, individuals, care providers, communities, and researchers should have anarray of interoperable health IT products and services that allow the health care system to continuously learn and advance the goal of improved health care.” ONC outlines five critical building blocks for achieving its goals, while also revealing its expectations for three, six, and 10 years down the road. The five building blocks include:

  • Core technical standards and functions.

  • Certification to support adoption and optimization of health IT products and services.

  • Privacy and security protections for health information.

  • Supportive business, clinical, cultural, and regulatory environments.

  • Rules of engagement and governance.

The three-year priorities revolve around improving health information networks and scaling existing models for fluidly exchanging health information across vendor platforms to support care transition and public health. The agenda use cases they provide as examples include: 

  • Individuals being able to look up their electronic immunization histories when needed.

  • Primary care providers sharing a basic set of patient information with specialists during referrals, and specialists sending updated basic information back to the primary care provider. 

  • Hospitals automatically sending an electronic notification and care summary to primary care providers when their patients are discharged. 

The six-year priorities revolve around having individuals be more active participants in their care, supporting team-based care and health information exchange, integration of data aggregators, monitoring of health disparities, and quality improvement opportunities, with automation of continuous quality improvement processes and clinician decision support. The agenda use cases they provide as examples include: 

  • Individuals integrating data from their health records into apps and tools that enable them to better set and meet their own health goals. 

  • Primary care providers and authorized researchers being able to understand how well-controlled diabetic patient population’s glucose levels are and how often those patients have been hospitalized based on standardized information from multiple sources. 

  • Clinical settings and public health connecting through bidirectional interfaces that enable seamless reporting to public health departments and seamless feedback and decision support from public health to clinical providers.

The 10-year priorities revolve around better health for all through a connected healthcare system and active individual health management, including improved information sharing at all levels of public health and the point of care. This includes standard data collection, sharing, and aggregation for patient-centered outcomes research, and targeted clinical decision support, taking into account genetics and local public health trends. The agenda use cases they provide as examples include:

  • Individuals managing information from their own electronic devices and sharing that information seamlessly across multiple electronic platforms as appropriate to healthcare providers, social service providers, consumer-facing apps and tools, etc. 

  • Primary care providers selecting effective medications for patients with certain conditions based on their genetic profiles and results of comparative effectiveness research.

When the vision report’s release was announced in June, DeSalvo emphasized the importance of getting feedback from multiple stakeholders, especially in light of ONC’s recent reorganization and streamlining due to decreased federal funding. “Interoperability… is so complex,” she said. “It requires all of us to have some shared responsibility thinking through how we’re going to get there in a way that meets everyone’s needs and expectations.” The report itself says, “No one person, organization, or government agency alone can realize this vision of an interconnected health system.” CT


Marsha K. Millonig, R.Ph., M.B.A., is president of Catalyst Enterprises, LLC, in Eagan, Minn. The firm provides consulting, research, and writing services to help healthcare industry players provide services more efficiently and implement new services for future growth. The author can be reached at mmillonig@catalystenterprises.net.