The Path to Health IT Interoperability

David Muntz and Nora Super | September 18, 2013

When HITECH was enacted, we understood our mission to be two-fold as the nation moved toward improved health and healthcare through the use of information technology.

  1. First, we need to achieve the adoption of certified health IT. Since the law’s enactment, we have made good progress towards achieving this goal.  We know from the hospitals and clinicians that have achieved meaningful use that it is hard work and the payment represents an important milestone of achievement.
  2. Second, we want to ensure that the systems that have been put in place are interoperable. Some key policymakers and stakeholders have questioned whether HHS has a clear path to Health IT interoperability.  To address these concerns, we have developed a new whiteboard animation to help explain how HHS is using multiple policy levers, and substantial public-private collaboration, to achieve Health ITinteroperability.

Interoperability is the ability of two or more systems to exchange health information and use the information once it has been received. It will take time for all types of health IT to be fully interoperable.

Achieving Health IT interoperability depends on five elements:

  1. Adoption and Optimization of EHRs and HIE services
  2. Standards to Support Implementation and Certification
  3. Financial and Clinical Incentives
  4. Privacy and Security
  5. Rules of Engagement or Governance

Step 1 towards Health IT interoperability: Adoption and Optimization of EHRs and HIE services

To achieve Health IT interoperability, we must first adopt and optimize Electronic Health Records (EHRs) and Health Information Exchange (HIE) services. Paper-based health records, which most doctors and hospitals used until recently, are usable by only one person at a time at one location.  Electronic files allow information to be exchanged and used simultaneously and securely by authorized users from multiple locations.

Like EHRs, health information exchange (HIE) services must also be optimized, adopted, standardized and used by health care providers and their patients in order to advance interoperability. Development and adoption of exchange services that are based on national standards, like Direct, make it easier for providers to exchange and use information even when they work in different organizations and with different health IT systems.

Step 2 towards Health IT  interoperability: Standards to Support Implementation and Certification

The 2014 Edition Standards and Certification Criteria Rule define the common content, format, and structured data that must be used in order for these systems to be certified.  These standards enable providers to share information as patients transition from one care setting to another, which is critically important to support patient care, ensure safety, improve quality, and lower costs.

ONC works to accelerate Health IT interoperability standards adoption and use by:

  • Convening standards implementers through the Standards and Interoperability Framework to develop shared, workable solutions to common information exchange challenges.
  • Providing support and testing tools for the developer community to assist them in developing standards-based, interoperable health IT systems through the standards and implementation environment.
  • Working with implementers to develop workable and scalable models for key exchange use cases, packaging needed standards, and policies all sensitive to the impact on work flows.
  • Certifying health IT systems against consensus standards so that providers using disparate, competing products can communicate. ONC Certified HIT products can be found on the CHPL (Certified Healthcare Products List).

Step 3 towards Health IT interoperability: Financial and Clinical Incentives

Financial and clinical incentives must be provided to health care providers and IT developers if we are to achieve EHR interoperability on a system-wide scale. The Medicare and Medicaid EHR Incentive programs provide financial incentives to eligible providers for adopting and meaningfully using EHR products, a critical first step.

Health IT is a fundamental component of new payment and delivery system models which rely heavily on information sharing across practices and health systems. By moving from a reimbursement system that pays providers for volume of treatments to a system that pays for the quality of care, providers will see benefits in using health IT to manage information about their patients.

HHS is looking at leveraging other HHS programs, resources and policies to promote EHR interoperability and information exchange. The overarching goal is to develop and implement a set of policies that encourage providers to exchange health information routinely through interoperable systems in support of care coordination across health care settings.

Step 4 towards Health IT interoperability: Privacy and Security

Patients must trust their providers to keep health information safe and secure, especially if it follows the patient to other points of care. Privacy and security is a shared responsibility between all participants in the health delivery process including the government, developers, health plans, providers and patients.

HIPAA limits the use and disclosure of health information. The HIPAA Security Rule requires providers to have administrative, technical, and physical safeguards for electronic identifiable health information. The EHR Incentive Programs require providers to conduct and periodically review a security risk analysis in accordance with the HIPAA Security Rule as part of the meaningful use core objectives.

HHS has taken steps to encourage and require EHR developers to build security into their products and ONC has included a number of security-related capabilities in the 2014 edition standards and certification criteria.

Step 5 towards Health IT interoperability: Rules of Engagement

HHS has implemented a framework for defining and implementing nationwide trusted exchange that promotes good governing practices within and across communities. The framework includes four categories of principles:

  1. Trust principles that guide health information exchange governance entities on patient privacy, meaningful choice, and data management in health information exchange;
  2. Business principles that focus on responsible financial and operational policies for governance entities, with emphasis on transparency and health information exchange with the patients’ best interests in mind;
  3. Technical principles that express priorities for the use of standards in order to support the Trust and Business Principles as well as furthering the execution of EHR interoperability; and
  4. Organizational principles that identify generally applicable approaches for good self-governance.