Interoperability to help achieve better care, smarter spending, and healthier people

Dr. Karen B. DeSalvo and Erica Galvez | January 30, 2015

Today, we issued Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0 (“Roadmap”).  This Roadmap reflects nearly a year of collaborative effort with extensive input from the public and private sectors and is a call to action to see that we can unlock digital health information and see that it can be appropriately used when and where it matters most, to who matters most – the people of this nation.  We articulate a vision and path forward that will require shared action between the public and private sector to create a health ecosystem that delivers better care, spends health care dollars more wisely, and results in healthier people.

This Roadmap builds out the ideas ONC raised in A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure released in June 2014.  We heard loudly and clearly that it was time to focus on interoperability as a priority and we articulated why the time is now to achieve the vision.  First, as a nation, we have made significant progress in digitizing the care experience such that there is now data to be shared.  Second, consumers increasingly expect and demand real-time access to their electronic health information.  Third, evolving delivery and payment models are driving appropriate data sharing.  Fourth, best practice models of information exchange and interoperability across the nation indicate it is possible to achieve. Fifth, technology is evolving in ways that will greatly simplify the challenge.  And sixth, opportunities to improve care and advance science in a learning health system environment demand rapid action.

Informed by your input and feedback we acted on this opportunity. Throughout the process, we received input from hundreds of health and health IT experts from across the nation through ONC Federal Advisory Committees’ (FACAs) feedback, whose membership includes 167 representatives from over 140 private and public organizations, as well as 25 federal partners, 90 individuals from 38 states, a host of  listening sessions and an online forum.

The Roadmap released today describes the critical pathway to realizing this vision and the impactful actions we believe need to be prioritized and taken.

Establishing clear standards is the first priority.  With today’s announcement, ONC is delivering on this assignment with the release of the 2015 Interoperability Standards Advisory: The best available standards and implementation specifications (“Standards Advisory”).  The Standards Advisory represents ONC’s assessment of the best available technical standards and implementation specifications for clinical health information technology interoperability as of December 2014. Overall, the Standards Advisory is meant to serve two purposes: to provide the industry with a single, public list of the standards and implementation specifications that best enable specific clinical health information interoperability purposes; and, to prompt dialogue and reach consensus among industry stakeholders when more than one standard or implementation specification could be listed as the best available.

Next we must create incentives that motivate the use of those standards. Earlier this week, the Department of Health and Human Services Secretary Sylvia Burwell announced new goals to aggressively transition Medicare payments away from traditional fee-for-service toward alternative payment models like Accountable Care Organizations. These new models will help create an environment where interoperability makes business sense. These, coupled with other actions like the Meaningful Use program, procurements, grant expectations and the expectation by  private payers that providers and health IT developers will use these standards, will lead to their adoption.

It is necessary but not sufficient to have clear standards and motivate their use.  We must also have clear rules of the road to govern how people’s electronic health information will be collected, shared, used and how privacy and security will be protected.  This trust is critical to a functioning, sustainable and vibrant interoperable health IT ecosystem.  There must be agreement on the policies, operations and technical standards that give data trading partners, including consumers, confidence that information is secure, used only for appropriate purposes, and that privacy preferences are honored. This trust is key to building systems that can accurately capture and use personal health information in the way the consumer wants their information to be used.  Finally, incorporating patient-generated health data and ensuring the availability of tools for individuals to use this information to manage their health and make more informed health-related decisions will lead to a truly patient-centered health care system.

Since the release of the vision paper in June 2014, we have heard and listened to many of you around the nation about how we – providers, consumers, developers, policymakers, the public health community and the science community – should collectively chart a path forward to interoperability, and we hope you see the fruits of your input in the draft Roadmap issued today. But our work is not done. We need you to continue to help refine our path. Read and comment on the draft Roadmap and the Standards Advisory.  Comments on the draft Roadmap can be shared at and are due by April 3, 2015. Comments on the draft Standards Advisory can be shared and are due by May 1, 2015.

As a nation, we have made great strides in encouraging and supporting the adoption of electronic health records.  Moving beyond this, however, we need to be able to unlock health information so it can be better used to help improve individual and public health. The goal of this shift is to achieve a nationwide learning health system—an environment that links the care delivery system with communities and societal supports in “closed loops” of electronic health information flow, at many different levels, to enable continuous learning and improved health that reaches everyone in this nation.