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ONC Policy Committee Questions JASON Report

September 4, 2014
by Gabriel Perna
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Members of the Office of the National Coordinator for Health IT’s (ONC) Health IT Policy Committee dismissed many of the findings of the JASON report, saying it used old data to reach its conclusions.

The JASON report was released in April of this year. It concluded a lack of interoperability in healthcare IT systems has become a major impediment to the development of a robust health data infrastructure. Conducted by JASON , an independent group of scientists that advises the U.S. Government on matters of science and technology, researchers looked at current challenges that must be overcome in enabling progress in creating a health data infrastructure that can live up to the promise of its many benefits, which include improved care and lowered costs.

The report basically concluded that Stages 1 and 2 of meaningful use have not achieved interoperability “in any practical sense” for clinical care, research, or patient access. They said there was a lack of architecture supporting standardized application program interfaces (APIs), as well as electronic health record (EHR) vendor technology and business practices, as structural impediments to achieving interoperability. 

After the report was released, the Health IT Policy Committee (HITPC) charged several of its members to review these findings and synthesize feedback based on the report. Led by David McCallie Jr., M.D. of the Cerner Corporation and Chair of the HITPC’s Architecture, Services, and Application Programming Interfaces (APIs) workgroup and Micky Tripathi, Ph.D. of the Massachusetts eHealth Collaborative (MAeHC) and Chair of the HITPC’s Interoperability and Health Information Exchange workgroup, the JASON Report Task Force concluded that the findings were not entirely accurate.

For one thing, the task force said the JASON report reached its conclusion 18 months ago, six months before the beginning of Stage 2 of meaningful use. The task force said that in this time span there has been a “positive change in the trajectory of interoperability progress.” Tripathi also said that the demand for interoperability has grown dramatically in the last 18 months.

Tripathi, McCallie, and co. said that the ONC should take into account the current state of interoperability before adopting the JASON report’s findings. “We believe that JASON did not adequately characterize the progress made in interoperability, though we agree that there is considerable room for improvement as will be outlined in these recommendations,” they wrote in a power point slide.

The task force also dismissed the JASON report’s findings that Direct and Consolidated Clinical Document Architecture (CCDA) are dead ends. They say that meaningful use was designed over time to allow for market adjustment, which makes that concern misplaced. They do agree that attention should be focused improving interoperability for document-based and data-based exchange through standardized APIs.

They also said that the JASON report ignored many EHR functionalities in its report including computerized processing order entry (CPOE), clinical decision support (CDS), and workflow orchestration. Instead, JASON called current EHR systems “stovepipe legacy systems.” Overall, the task force said that many EHR systems are a lot more sophisticated and dynamic than the JASON report gives them credit for.

According to Politico, some members of the committee fell more in line with the JASON report than the task force. Marc Probst, CIO of Intermountain Healthcare, said he is skeptical that the industry will be able to create interoperability, because it is government-driven.  The JASON task force is set to make recommendations in less than a week.

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