Catalyst Corner

The ONC’s Draft Roadmap Recognizes Pharmacy ––>

Continuing work toward achieving its strategic plan, the Office of the National Coordinator for Health Information Technology (ONC) released a draft interoperability report in January entitled “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap.” The ONC accepted public comments through April 3, and will now be studying those comments with the goal of releasing an updated report later in the year. Of note, the report mentioned both pharmacists and pharmacy in various sections when referring to healthcare providers.

The draft roadmap’s purpose is to provide a three-year framework for moving toward an interoperable health IT system that allows information to be collected, shared, and used to improve health, facilitate research, and support clinical outcomes. The roadmap is based on a core set of actions needed to achieve interoperability, which 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.

According to the roadmap, the most critical areas to produce near-term wins toward the goal of interoperability are four-fold, and include:

■ Establishing a coordinated governance framework and process for nationwide health IT interoperability.

■ Improving technical standards and implementation guidance for sharing and using a common clinical data set.

■ Enhancing incentives for sharing electronic health information according to common technical standards, starting with a common clinical data set.

■ Clarifying privacy and security requirements that enable interoperability.

To achieve the first goal, the ONC is working to establish a governance framework with overarching rules of the road for interoperability of health IT, a public/private process for addressing implementation or operational-level issues, and a method for recognizing the organizations that comply with the rules and holding them accountable for continuing to do so. The goal is to finish this work by 2017.

With regard to the second goal of improving technical standards and implementation guidance for sharing and using a common clinical data set, the roadmap notes that both clinical documents and discrete data element access will continue to be used. The authors note, however, that the purpose for health information sharing should drive technical standards. The common clinical data set that is proposed is in the box at right.

Pharmacy system vendors would be wise to review this list, as well as the best standards to achieve interoperability recommended by the ONC. Those standards are part of a separate report, called the 2015 Interoperability Standards Advisory. The report may be found at The advisory is the way the ONC will identify, assess, and determine the best available interoperability standards and implementation specifications for industry use toward specific healthcare purposes.

With regard to the area of incentives, the roadmap says the Medicare and Medicaid Electronic Health Care Record Incentive Programs alone do not create enough economic incentives to achieve interoperability across the care continuum. As a result, the authors of the roadmap call for federal, state, and commercial payers to evolve policy and funding levers to incentivize information sharing according to technical standards designated through the ONC’s Health IT Certification Program.

Regarding privacy, the roadmap simply reinforces that most health information still resides in provider systems that are bound by HIPAA, and that covered entities and business associates need to remain vigilant.

The Purpose of Health Information Sharing

As part of the goal to improve technical standards, the ONC’s roadmap calls for a common clinical data set, which includes the following:

• Patient name

• Sex

• Date of birth

• Race

• Ethnicity

• Preferred language

• Smoking status

• Problems

• Medications

• Medication allergies

• Laboratory test(s)

• Laboratory value(s)/result(s)

• Vital signs

• Care plan field(s), including goals and instructions

• Procedures

• Care team members

• Immunizations

• Unique device identifier(s) for a patient’s implantable device(s)

• Notes/narrative 

Pharmacists and pharmacies are among the specific stakeholders for whom the roadmap is applicable. The roadmap says that by 2024, individuals, care providers, communities, and researchers should have an array of interoperable health IT products and services that support continuous learning and improved health. They consider pharmacists and pharmacies among the set of care providers noted. Specifically, the roadmap states:

“For purposes of this Roadmap, the term care providers is broadly inclusive of the care continuum and includes individuals and organizations that hold professional licenses and certifications that grant them permission to play a role in the treatment of individuals as part of a community. This includes providers such as primary care physicians, specialists, nurses, physical therapists, pharmacists, dentists, social workers, optometrists and other allied health professionals, as well as organizations such as hospitals, public health departments, mental health and substance abuse services, long- term and post-acute care facilities, home and community-based services, other support service providers, care managers and other authorized individuals and institutions.”

Pharmacy system vendors, as entities that provide for data and information exchange, should note the roadmap’s related governing principles to ensure that standards are prioritized, developed, and implemented to support the public interest, national priorities, and the rights of individuals. Specifically, vendors are to:

■ Use federal vocabulary, content, transport, and security standards and associated implementation specifications when available.

■ Use standards that support data portability from one health IT product to another.

■ Develop and implement technical requirements to meet current and future user needs.

■ Use standards that do not unfairly provide an advantage to one sector or one organization over others.

In addition, for 2015–2017 providers are called upon to routinely leverage standards-based health IT to support prioritized workflows, including:

■ Closed-loop transitions of care.

■ Secure clinical communications.
■ Prior authorizations, medication co-pays, and imaging appropriateness.

■ Computerized physician order entry (CPOE) for services and diagnostic testing.

■ E-prescribing of controlled substances with concurrent availability of PDMP data.

By 2018–2020 expanded use should address the following plug-and-play clinical decision support services:

■ Electronic consultations.

■ Reporting to specialty society registries.

■ Reporting to value-based payment programs.

■ E-prescribing supported by complete medication fill history.
■ Discovery and incorporation of information from patient-owned devices with tools for reconciliation and validation.

■ Recommendation of patients to relevant studies and trials.

■ Exchange of information to support comprehensive medication management and medication therapy management (MTM) services.

An entire section of the roadmap is dedicated to discussing comprehensive medication management. The pharmacist’s role and value in providing these services is outlined as follows:

So what’s up next for the roadmap? The ONC plans to publish future versions of Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap, which is intended to be a living document that will be guided and evolved by all health and healthcare stakeholders.

“Pharmacists are health care professionals with skills and expertise that uniquely position them to work with other healthcare providers to successfully manage patient mediation therapies. Pharmacists routinely consult on choice and selection of appropriate medication therapies, evaluate the effectiveness of treatment by monitoring clinical endpoints such as laboratory values and patient-reported outcomes, recommend dosing adjustments to tailor clinical response, access the safety profile of medications and evaluate patient risk for adverse outcomes, monitor and evaluate patient adherence and counsel patients on appropriate use and understanding of their treatments.”

That section of the roadmap concludes that, in regard to pharmacist’s efforts, “technological barriers to information exchange limit the ability of MTM documents and associated recommendations to be shared with ease between settings of care.”

So what’s up next for the roadmap? The ONC plans to publish future versions of Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap, which is intended to be a living document that will be guided and evolved by all health and healthcare stakeholders. Updates are planned every two years. The roadmap can be accessed at: default/files/nationwide-interoperability-roadmap-draftversion-1.0.pdf. 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@