An Oct. 15 joint Health IT Policy/Standards Committee meeting approved a set of task force recommendations that the Office of the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services focus effort on a public API (application programming interface) specification. But committee members asked to remove language suggesting that CMS and ONC should consider delaying or staggering meaningful use Stage 3 to accommodate an accelerated development process for an initial public API.
“Meaningful use Stage 2 experience shows that overly broad and complex requirements slow progress on all fronts,” Micky Tripathi, CEO of the Massachusetts eHealth Collaborative and co-chair of the JASON Task Force, told the joint committee meeting. A focus on interoperability will send a strong signal to the market and allow providers and vendors to focus their resources, he said. “On the task force, there was consensus that this narrow focus is the way to go.”
But some members of the two federal advisory committees balked. While supportive of the work on public APIs, Christine Bechtel, of the Bechtel Health Advisory Group, said she couldn't support recommendations to delay Stage 3 requirements. “I am not sure you have looked at what we would lose,” she said. “There are some really important advancements around provider notifications, clinical decision support and patient-generated health data.”
Committee member and entrepreneur Paul Egerman questioned whether loading public APIs into Stage 3 makes sense. “The experience with Direct might guide us,” he said. “People liked the idea, but it hasn’t been a huge success. We run the same risk here,” he said.
Yet others expressed optimism about the change in direction that a shift in focus away from document-centric exchange would mean. “What you are proposing represents a profound change for provider experience,” said Jeremy Delinsky, senior vice president and chief technology officer at athenahealth Inc. A major benefit would be fundamental changes in what data looks like to a provider, he said. So much of the data being exchanged now is pushed rather than pulled, because the documents don’t make any sense to providers. Consuming a document is laborious. An API would offer a far more real-time, automated way to incorporate outside data. With document-based exchange, we will never get there, he said.
The task force has noted that FHIR (Fast Healthcare Interoperability Resources) and FHIR profiles are currently the best candidate API approach to data-level access to healthcare data. (FHIR is a standard under development by HL7.)
Tripathi and co-chair David McCallie, senior vice president of medical informatics at Cerner, introduced other task force recommendations:
• ONC should immediately engage the federal advisory committees to further flesh out Jason Task Force recommendations on Public API-based architecture.
• ONC should immediately contract with a standards development organization or other recognized operationally active industry consortium to accelerate focused development of initial Public API and Core Data Services and Profiles for inclusion in MU Stage 3 and associated certification.
The task force also recommended that ONC develop a public-private vision and roadmap for a nationwide coordinated architecture for health IT. The coordination should target enabling and encouraging HIT market forces towards developing Data Sharing Networks that can leverage a new Public API that exposes Core Data Services and Core Data Profiles.
They recommended that the coordinated architecture should be based on the use of a public API that can enable data- and document-level access to EHR-based information in accordance with modern interoperability design principles and patterns. They recommend that the first uses of the public API should support data-sharing networks that promote EHR-to-EHR interchange, and consumer access to the core data services via patient portals.
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