Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap – Version 1.0

Dr. Karen B. DeSalvo and Erica Galvez | October 6, 2015

This is a unique time in health care. Scientific and technological advancements made by you, our partners across the health industry, have been rapidly transforming health and health care in the nation. More than 3 million individuals have accessed their electronic health information using ONC’s Blue Button tool. Today, over three-quarters of eligible providers and nine-in-ten eligible hospitals have received incentive payments for adopting and meaningfully using certified health IT compared with less than 15% before the Medicare and Medicaid EHR Incentive Programs started. Americans should be able to build a longitudinal picture of their health, rather than experience care as a series of disjointed, singular episodes. Together, our efforts to make critical health information electronically available when and where it matters most is shifting the industry toward providing better care, smarter spending of health care dollars, and most importantly a healthier nation.

Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap – Version 1.0 Final (Roadmap) lays out the milestones, calls to action and commitments that public and private stakeholders should focus on achieving, particularly in the near-term. In January 2015, the Office of the National Coordinator for Health IT (ONC) requested public comment on the draft version of the Roadmap. We received over 250 comments which were used to shape the Roadmap released today. Additionally, the Roadmap was informed by the input from 25 federal partners, 90 individuals from 38 states from across the nation and the ONC Federal Advisory Committees (FACAs), whose membership includes 167 representatives from over 140 private and public organizations.

As of 2014, nearly nine-in-ten hospitals that engage in all four interoperable exchange activities (i.e., send, receive, find, and use) have necessary clinical information electronically available from outside providers or sources when treating patients[1]. This demonstrates that we must continue, in the near-term, to focus on ensuring that systems can send, receive, find and use the priority data domains to ensure electronic health information is securely available to improve health care quality and outcomes.   Achieving these four exchange activities is part of the foundation that is necessary for the nation to continue making progress and push information sharing beyond electronic health records (EHRs) to include technologies that empower the American public by putting them at the center of their own care.

There are four pathways that will lead us to meet our near-term goal:

  • Improve technical standards and implementation guidance for priority data domains and associated elements. In the near-term, the Roadmap focuses on using commonly available standards, while pushing for greater implementation consistency and innovation associated with new standards and technology approaches, such as the use of application programming interfaces (APIs).
  • Rapidly shift and align federal, state, and commercial payment policies from fee-for-service to value-based models to stimulate the demand for interoperability.
  • Clarify and seek alignment of federal and state privacy and security requirements that enable interoperability.
  • Coordinate among stakeholders to promote and align consistent policies and business practices that support interoperability and address those that impede interoperability, in coordination with stakeholders.
  • Align and promote the use of consistent policies and business practices that support interoperability and address those that impede interoperability, in coordination with stakeholders.

To support the advancement of health IT across the care continuum ONC recently released the 2015 Edition Health IT Certification Criteria final rule (2015 Edition final rule). The 2015 Edition final rule supports interoperability across the care continuum (e.g., behavioral health and long-term and post-acute care settings) through the certification of health IT to standards and functionalities, including relevant privacy and security capabilities that facilitate the secure structured exchange of health information between providers and with patients. The 2015 Edition focuses on and provides technical standards implementation guidance for the priority data domains outlined in the Roadmap.

The Roadmap is also directly linked to the Federal Health IT Strategic Plan 2015-2020 (Plan) and 2016 draft Interoperability Standards Advisory (ISA). ONC worked with federal partners to develop the Plan, which illustrates how federal initiatives and programs help people, populations, and communities achieve health and well-being through the use of health information and health IT. Finalizing and implementing the Roadmap falls into Goal 4 of the Plan which aims to enhance the nation’s health IT infrastructure. The ISA represents the model by which ONC will coordinate the identification, assessment, and determination of the best available interoperability standards and implementation specifications for clinical health IT. The draft 2016 ISA is currently available for public comment. In the future, the scope of the ISA may be expanded as necessary and appropriate to support the Roadmap’s evolution as well as other national priorities.

The Roadmap is intended to be a living document. As we progress on this journey, future versions of the Roadmap will continue to be informed by public and private sector stakeholder feedback and will be updated as milestones are met and new challenges emerge.

While together we have come a long way and are thankful for your involvement thus far, much work still remains to be done. In the near-term, the collaboration of stakeholders to fulfill the calls to action and commitments is critical to advancing nationwide interoperability.  Over time our collective efforts will shift to expand the interoperable health IT ecosystem to include other data sources and users that form a learning health system that puts the person at the center, can continuously improve care, public health and science through real-time data access. I am excited to continue on this journey with you to improve the health of consumers no matter where they live, work and play.

To read the final Roadmap version 1.0, please visit

To read public and private-sector statements of support for the final Roadmap, please visit

[1] Charles D, Swain M Patel V. (August 2015) Interoperability among U.S. Non-federal Acute Care Hospitals. ONC Data Brief, No. 25 Office of the National Coordinator for Health Information Technology: Washington DC.