Developing a Shared, Nationwide Roadmap for Interoperability

When we issued our interoperability vision paper, Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure, in June, and the HHS Principles and Strategy for Accelerating Health Information Exchange last year, we promised that the journey would be collaborative.  I am pleased to say we are delivering on this promise and launching a new, interactive community on

Over the course of the coming months we will be drafting a document, with input from you – stakeholders who may be interested in contributing. The goal is to develop version 1.0 of a nationwide interoperability roadmap.  The roadmap will be a companion to our vision paper and dive deeper on how we can collectively achieve the 3, 6, and 10 year interoperability milestones described in the paper.  Our ultimate goal is to have a learning health system where accurate and evidence-based information helps ensure the right individual receives the right care at the right time to increase health care quality, lower health care costs and improve population health.

To ensure this nationwide roadmap represents the needs and interests of the nation, we need to hear from a broad array of stakeholders and their perspectives.  We have several efforts underway to gather feedback through listening sessions, subject matter experts, states, other federal agencies, and workgroups within our Federal Advisory Committees (JASON Taskforce and Governance sub-workgroup). 

The new community we are launching on is a general solicitation of public input for the nationwide interoperability roadmap.  The interoperability community is intended to give everyone an opportunity to provide input on the most critical elements of the roadmap, allows for comments and feedback and includes specific questions that need to be addressed.  We invite you to become part of the community, respond to some or all of the questions in a manner you prefer, and even subscribe to receive updates when others post their input and feedback.

We are asking that everyone provide their thoughts and comments by Friday, September 12, 2014.  That will give us time to synthesize all of the suggestions and feedback and account for as much of it as possible in the draft roadmap that will be presented to our Federal Advisory Committees for their input and recommendations in October.  We anticipate an updated version reflecting the Advisory Committee feedback to be posted for public comment in early 2015.

Please also note that we expect the roadmap to be a living document updated with collective input on a regular basis.  We know we won’t get everything right the first time around, but also know that achieving interoperability in health IT is a journey, not a destination.


  1. Lynn Etheredge says:

    A 3-Part Proposal

    1. Require HHS Sec-ONC to establish a basic data set for federally-subsidized EHRs. Use the 10+ areas that are already standardized in the HMO Research Network’s Virtual Data Warehouse (VDW) as elements to be included:

    We know these basic data elements all can be standardized & interoperable NOW, and that this is a core data set that is of proven value not only to our largest health plans for quality care, but also for a great deal of research — HMO RN (VDW) is the core of the nation’s largest data-sharing research networks, like FDA’s mini-Sentinel, NIH’s HCS Collaboratory, e.g.

    Note: this is likely 10% or less of the total data in EHRs – leaves out progress notes, etc. If we have national data standardization for diagnosis, treatment, Rx, labs, etc. we will have the core of what we need for most clinical care and studies. Easily done, quickly. Require initial standards for public comment issued by Dec 1, 30 day comment, final rule 90 days thereafter. (?)

    2. Require HHS (NIH & FDA) to develop “Master Protocols” for all major clinical research areas NIH has recently adopted this method, starting with lung cancer, as a way to assure data standardization and interoperability in its supported research. Patient groups, Rx, researchers & clinicians are supportive, as this strategy will serve all of their needs. For details, see: The lung cancer MAP will be used by more than 200 cancer centers.

    3. Require HHS Sec to mandate that all federally-subsidized EHRs must accept & work with Apps and modules that capture and report “Master Protocol” data.

    In this way, all basic EHRs can be upgraded to national “Master Protocol” standards, as they are developed and issued by HHS, so all EHRs become capable of contributing standardized, interoperable data to a “learning health system”.
    Mandate effective, Jan 1 2014. (?)

    Lynn Etheredge
    Rapid Learning Project

  2. Wounded warrior says:

    I’m glad to see health related infrastructure being looked at in new ways, there is such a need for a higher level and more efficient way of treating a patient

  3. Laura Dawson says:

    Yes, Dr. Karen DeSalvo, that was our purpose when the Electronic Health Records passes by us on the table and we created a method of credentialing our design with a group in Chicago. I worked within the site and other panel meetings. We then took on the largest existing group of patients to work out any kinks under the Meaningful Use Stage 1 period. While I am a credentialed acupuncturist, my clinical experience was valuable to make the data systems more humanistic and functional. We designed a system used to remind the patient, based on projected possible health challenges of the screening or test that may be wise. We built in a prevention style in order to improve accessibility, affordability, and quality of life for the patient base. Just as so many things do, it has gotten way-layed by state ideas for improvement on a smaller scale. That is where the problem lies. Developing a shared, nationwide roadmap for interoperability will again be a challenge, simply due to the lack of compliance and the nature of a country established by independent thinkers. That way why the large dollar incentives were provided to physicians who would convert to EHRs. If we can get the medical community to understand just how far down the scale of quality health care systems the US is, they may be willing, although there a very few people who enjoy making a significant change until is it done. Best to you and your team.

  4. Valerie J H Powell says:

    The scope of any EHR technology that doesn’t include oral health care records is inadequate and flawed. It would fall, from the standpoint of philosophy, under the fallacy of composition.

    According to Allareddy V, Rampa S, Lee MK, Allareddy V, Nalliah RP (2014). Hospital-based emergency department visits involving dental conditions: Profile and predictors of poor outcomes and resource utilization. J Am Dent Assoc 145(4): 331-337. doi:10.14219/jada.2014.7, about every 10 days somewhere in the U.S., an Emergency Department patient dies of a dental condition.
    See also: Nalliah RP, Allareddy V, Allareddy V (2014). Dentists in the US should be integrated into the hospital team. Brit Dent J216(7):291-392. doi: 10.1038/sj.bdj.2014.245 and,
    from Australia, Hwang T, Antoun JS, Lee KH (2014). Features of odontogenic infections in hospitalized and non-hospitalised settings. Emerg Med J 28:766-769 doi:10.1136/emj.2010.095562.

    Microbiology has shown the role of oral microbes in stillbirth and colorectal cancer:
    Rubinstein MR, Wang X, Liu W, HaoY, Cai G, Han YW (2013). Fusobacterium nucleatum Promotes Colorectal Carcinogenesis by Modulating E-Cadherin/β-Catenin Signaling via its FadA Adhesin. Cell Host & Microbe 14, 2: 195-206.

    Also: Kostic AD, Chun E, Robertson L, Glickman JN, Gallini CA, Michaud M, Clancy TE, Chung DC, Lochhead P, Hold GL, El-Omar EM, Brenner D, Fuchs CS, Meyerson M, Garrett WS (2013).Fusobacterium nucleatum Potentiates Intestinal Tumorigenesis and Modulates the Tumor-Immune Microenvironment. Cell Host & Microbe 14, 2: 207-215.

    Han YW, Fardini Y, Chen C, Iacampo KG, Peraino VA, Shamonki JM, Redline RW. (2010) “Term Stillbirth Caused by Oral Fusobacterium nucleatum,” Obstetrics & Gynecology 115, 2: 442-445.

    Microbiology shows us this: Boland MR, Hripcsak G, Albers DJ, Wei Y, Wilcox AB, Wei J, Li J, Lin S, Breene M, Myers R, Zimmerman J, Pappanou PN, Weng C (2013). Discovering medical conditions associated with periodontitis using linked electronic health records. J Clin Periodontol. 2013; 40(5): 474–482. doi:10.1111/jcpe.1208

    About perpical abscess, using NEDS data from U.S. EDs: Allareddy V, Lin CY, Shah A, Lee MK, Nalliah R, Elangovan S (2010). Outcomes in Patients Hospitalized for Periapical Abscess in the United States An Analysis Involving the Use of a Nationwide Inpatient Sample. J Am Dent Assoc141(9):1107-1116.
    Nalliah RP, Allareddy V, Elangoyan, Karimbux N, Lee MK (2011). Hospital emergency department visits attributed to pulpal and periapical disease in the United States in 2006. J Endodont 37(1).6-9

    As a famous rabbi once is supposed to have said, if not now, when?

    Valerie Powell

  5. Pylori says:

    Interoperability needs to reach consumers, particularly those with chronic conditions. Chronic conditions often require significant self care by the the consumer / patient. Consider diabetes self management is the norm. Yet the devices we use to manage it are by and large not interoperable. Our meter , pump and CGM typically do not share data, the down load processes are kludgy and reports not relevant.

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