Speaking at a Bipartisan Policy Center event in Washington, D.C. on Dec. 8, Karen DeSalvo, M.D., National Coordinator for Health IT, announced that her health IT agency’s goal is to connect private and public health information exchanges (HIEs) in the entire country within a year.
Making the nation’s HIEs interoperable is among the Office of the National Coordinator for Health IT's (ONC) main 2016 priorities, DeSalvo said. “We have built—through the hard work of the private sector and states—an infrastructure where every state has an information highway. In some communities, it’s already connected across state lines. Our goal is to connect that highway, including the health information exchanges [and] the private sector exchanges, in the entire country within a year,” DeSalvo said. The aim, she said, is that information will be available to a patient’s provider wherever he or she might be in real time so that he or she can address the patient’s clinical needs.
Considering the numerous challenges that HIEs have had to date, many healthcare stakeholders might see DeSalvo’s goal as an unrealistic objective, especially when considering ONC’s recently-released final Interoperability Roadmap which states that, “by the end of 2017, the ONC intends for the majority of health providers and consumers to be able to send, receive, find and use a common set of clinical information in order to improve healthcare quality and outcomes.”
In September, for instance, the Government Accountability Office (GAO) released a report, “Nonfederal Efforts to Help Achieve Health Information Interoperability,” in which representatives from 18 health information exchange initiatives described a variety of efforts they are undertaking to achieve or facilitate interoperability. The stakeholders involved concluded that to date, interoperability has indeed remained limited.
A range of health IT experts have agreed with this sentiment in various interviews with Healthcare Informatics over the past several months. Arien Malec, vice president of data platform and acquisition tools for RelayHealth (the Alpharetta, Ga.-based McKesson business unit that focuses on improving clinical connectivity) said in an October interview with HCI that while the industry has made progress, “We are just not moving fast enough from a provider perspective, and that’s a perspective I absolutely agree with. We are in that place where we have a lot of electronic records and are starting major initiatives to connect them all, but we are in the middle of it and looks messy right now,” Malec said at the time.
Similarly, at the iHT2 Health IT Summit in New York in September (iHT2—a sister organization to Healthcare Informatics, under the corporate umbrella of parent company Vendome Group, LLC), David Blumenthal, M.D., former National Coordinator for Health IT and current president of The Commonwealth Fund, said in his keynote presentation, as reported by HCI Editor-in-Chief Mark Hagland, “Health information exchange remains a continuing challenge. Interoperability, which is technical,” also remains to some extent unresolved, Dr. Blumenthal said.
Nonetheless, DeSalvo said on Tuesday that connecting HIEs across state lines in 2016 “lays the foundation that we can build upon year over year to add more information to see that it can flow.” DeSalvo, who is also Acting Assistant Secretary for Health for the Department of Health and Human Services (HHS), additionally stated ONC’s goal to help the private sector expand the development and use of application programming interfaces (APIs). Providers are experimenting with new technology such as Fast Healthcare Interoperability Resources (FHIR) and apps, or “doorways to data,” DeSalvo said. “But rather than having them scattered in many pockets, they would like to have a challenge of who can come up with the best apps that will give consumers access to their data and doctors a user interface that will make more sense for them.” As such, ONC will host two challenges this year that will drive the best to the top, she said. The agency will also work with private sector on developing a prototype app store where providers would have a centralized place to go to if they want a better user interface for their system or if they want a way to access immunization records for instance, DeSalvo said.
Karen DeSalvo, M.D.
DeSalvo admitted that getting a connected health system has been a challenge due to several factors including: consumers being unable to get their data whenever and wherever they want; consumers being able to share that data; health information blocking occurring; and the industry competing between standards rather than within them.
As a solution to these problems, she said that “we need to work to develop the best standards agreed to by vendors so that the interfaces we have to built will get less expensive and easier over time.” DeSalvo also noted that ONC's health IT certification program is being used to prevent information blocking. Regarding patient data, she said, “We are about to reach a tipping point where everyone can have access to their data. The future is closer than we all think due to changes at not only the technology level, but also at the policy and systems level.”