A Robust Health Data Infrastructure

Today HHS posted a report by JASON, an independent group of scientists that advises the Federal government on matters of science and technology, called “A Robust Health Data Infrastructure.”

I am excited about the findings and encourage you to take a look at the report.  It is a comprehensive and thoughtful look at the technical challenges in our health information technology system and proposes a future state that is aligned with the Office of the National Coordinator for Health IT’s (ONC) vision for an effective and efficient interoperable health IT “ecosystem” that supports every individual in the care environment and beyond.

Supporting Interoperability

I am pleased that this report is consistent with our intent to support nationwide interoperability in a way that supports care, health and is flexible enough to meet the challenges of the future. The ONC and the Centers for Medicare & Medicare Services (CMS) have already begun to work on many of the recommendations cited in the report–although this represents the beginning, not the end of our efforts.   The JASON recommendations continue to challenge us to stay focused on the path ahead.

This report, done in partnership with and funded by our colleagues at the Agency for Healthcare Research and Quality (AHRQ) with input from the Robert Wood Johnson Foundation, comes at an important time in the transformation of our nation’s health care system.  It also comes at a pivotal time for the ONC.  We are evolving from the intense work created by the American Recovery and Reinvestment Act including the Meaningful Use program and our grant programs to spur adoption of certified, standard technology, connect care and providers towards improving population health, building capacity in the health-care system to address health IT in the care environment and supporting consumer access to their health information.

Looking Ahead

As we move forward over the next few years, we will be focusing much of our efforts on supporting advanced care models and completing electronic health record adoption across the spectrum of health care. We will use the policy levers available to support the electronic exchange of health information and support consumer engagement in health-care, while trying to reduce health disparities. Finally, we will strive to improve our EHR certification program – while we continue our strong support of the standards and technical infrastructure to reach our goals.

The JASON report builds upon our understanding of the technical, broad policy and privacy and security issues that are both opportunities and challenges as we advance an agenda of meaningful exchange and interoperability.

We look forward to discussing the report’s concepts and approach with our strategic partners and to expanding the scope to include a discussion about governance of the exchange and interoperability infrastructure. The goal is to create a supportive environment for uptake and sustainability. We will move swiftly in the next few months to refresh our Federal Health IT Strategic Plan and then to build a national consensus agenda on health IT.  We fully expect meaningful interoperability to be at the top of this agenda based upon what we have learned to far.

We look forward to engaging with our Health IT Policy and Standards Committees, but also across the health care industry, with consumers, providers, employers, purchasers and health IT developers as we evolve our roadmap for interoperability, a robust health IT infrastructure, and a shared set of priorities for our nation.


  1. John Moehrke says:

    This is an interesting document, however it seems to have ignored the success seen that uses the IHE XDS/XCA infrastructure. I hope that the HHS/ONC sponsored effort in IHE to uncover the Data Access Framework (DAF) is considered in future efforts. Please see the IHE public comment on this effort http://www.ihe.net/Public_Comment/#pcc

    S&I Framework page http://wiki.siframework.org/Data+Access+Framework+Homepage


  2. Barry Dickman says:

    This is a well-written document and driver for industry. I hope that ONC, HIMSS and industry will be promoting the importance of testing for interoperability and standards conformance in the electronic exchange of health information. ONC, HIMSS and the Vendor Community have the opportunity to mobilize the community to participate in the building and testing of open source interoperability solutions.

    Some proposed strategies to consider to ensure the success of the JASON Report – A Robust Health Data Infrastructure should include:
    • Support Automated Platform for Test Case Execution
    • Document Best Practices for Audits and Work Flow Lifecycle of Testing
    • Support an Environment for Re-Use of Testing Tools/Test Cases
    • Promotion Beyond “Happy Path Testing (peer-to-peer), ensure Negative Testing”
    • Promote Industry Reporting Metrics on how well their products and services ensure interoperability and not vendor lock-in.

    Barry Dickman
    AEGIS.net, Inc.
    Senior Consultant

    • Patti Marshall says:

      I agree wholeheartedly with your comments Barry and would add that you can’t leave process-based testing out of the picture (both end-to-end and user acceptance testing).

      You can have a system that is perfectly built and testing, but if the users don’t know how to use it, or they can’t understand the workflow, you will not succeed. While automated tools support functional and performance testing, tools that support subject matter experts participating in end-to-end and user acceptance testing, are becoming an essential part of the mix.

  3. Spencer Hamons says:

    The document is well-written and helps bring to the forefront the importance of interoperability. I do have a concern that we are putting the cart in front of the horse a bit, because while the report does identify all of these important aspects, it does not really address a critically important piece, which is that healthcare technology vendors need to embrace the concept of “vendor neutral architectures”. Too often, the major system / software vendors in the healthcare space attempt to corner hospitals, clinics, and health systems into utilizing specific underlying hardware technologies as a prerequisite for the use of these systems. For interoperability to become a reality, a hospital, clinic, or health system must be able to develop their own system architecture with acceptable levels of performance – and as long as that architecture performs utilizing industry standards at acceptable levels – then the software vendors should run on that infrastructure without issue.

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