The Office of the National Coordinator for Health IT on Jan. 30 released the Shared Nationwide Interoperability Roadmap, a plan for establishing the infrastructure to support a broad-scale "learning health system" by 2024.
The roadmap gives healthcare organizations motivation to move in concert with ONC’s goals, according to Kaveh Safavi, MD, global managing director of Accenture’s healthcare business.
"I expect to see significant progress toward interoperability over the coming months and years,” Safavi explained. “It is in the interest of providers to link capabilities sooner rather than later to enable access to meaningful insights that could lead to improved patient care.”
So, what happens next?
The roadmap specifies two primary targets intended to become realities over the next six years: first is the ability to send, receive, find and use a common clinical data set to improve health and healthcare quality by the end of 2017 and, second, ONC intends to fuel expansion of interoperable data to improve health and lower costs by the end of 2020.
Here's a look at what will be happening, and when, in core areas:
For the remainder of this year, existing communities will agree on a coordinated governance process and establish common rules of the road.
A coordinated governance process and single trust framework will be implemented in early 2016, and expanded through the end of 2020, with the rules of the road being maintained along the way.
Standards and interoperability
ONC will publish and update a list of the best available standards for interoperability between now and 2020.
The emerging FHIR (pronounced "fire") standard, developed by HL7, will come into play. FHIR specifications for querying a common clinical data set will be refined and piloted this year. Next year, developers will implement the FHIR spec for a common clinical data set.
The components of the clinical data set would be patient name, sex, date of birth, race, ethnicity, preferred language, smoking status, problems, medications/allergies, lab tests/results, vital signs, care plan, procedures, care team members, immunizations, identifiers for implantable devices and notes.
Similarly, specifications will be published this year for data provenance — the process of tracing and recording the origins of data and its movement between databases. Developers will implement the specs to meet industry needs starting next year and extending through 2020.
Version 2.0 of the Consolidated Clinical Document Architecture (C-CDA) standard will be released to the public by the middle of this year. C-CDA implementation guidance will follow through the end of 2016, and then developers will begin rolling out 2015-certified products in early 2017.
Drivers and regulations
ONC will clarify privacy and security requirements to enable interoperability this year by releasing proposed rulemaking for 2015 Edition certified EHRs and meaningful use Stage 3.
Next year, those proposed rules will be finalized, and then MU Stage 3 will begin in 2017.
Care providers and consumers
This year through the end of next year, providers "across the continuum" will be using 2014 and 2014 revision 2 certified products and services, according to ONC. During the same span, consumers will use online portals to access their health information.
Beginning in 2017, providers will upgrade to 2015 certified products and services. Correspondingly, consumers will aggregate health information from many portals into a single place through the use of apps.
The end goal
The operative phrase is a learning health system.
Such a scenario would be based on cycles that include data and analytics to generate knowledge. That knowledge would then be fed back to stakeholders, with the goal of changing behavior to improve health and to transform organizational practice.
A learning health system will require standards, appropriate incentives to motivate use of those standards, and the creation of a trusted environment for collecting, sharing and using electronic health information, wrote ONC chief Karen DeSalvo, MD in the foreword to the 166-page document.
A step-wise approach, in which high-level critical actions will produce near-term "wins," will be the path for reaching those targets, according to ONC.
Safavi expects interoperability by 2017 to be difficult to achieve but he said that the high level of innovation alongside ONC’s roadmap and meaningful use rules will help providers make progress in the coming months and years.
“The great unknown is whether providers will be able to complete this change within the next two years, which I believe is a noble goal, but could be a challenge to execute,” Safavi said.