Paul Tang, MD, MS, vice chair of the Health IT Policy Committee, offered up details about the Interoperability Task Force’s report to Congress on the clinical, technical, organizational and financial barriers to interoperability.  

Meaningful Use (MU) was very successful at increasing the use of EHR systems, he said. “We needed a critical mass of providers to have EHR systems that can exchange clinical information with other providers” to move toward an interoperable healthcare system. The federal EHR certification rules “played a critical role laying down some ground rules on what criteria a system has to have to promote interoperability which was necessary but not sufficient.”

While lab information exchange and electronic prescribing has been successful EHR-to-EHR interoperability has progressed more slowly due to fragmentation and diversity of providers and EHR systems. APIs are a promising development aligned with the rest of the internet economy and is a part of MU Stage 3, Tang said. Vendors are responding to requests to open up their systems and have information flow between systems.

Another issue is operational workflow. “Every time you stick in new technology it changes the workflow, many times for the better but it takes getting used to. In a fragmented system with so many parties involved, workflow isn’t similar from one area to another or from one worker to another. That slows our progress but we can overcome it.”

Privacy and security has always been challenging, Tang said, but digitalization uncovers how informal the practices were in the paper-based world. “Electronic systems require specific configurations which force formalization of policies and practices that in a paper-based world are more informally articulated.”

Interpretations of HIPAA have been shown to vary widely in the market and misinterpretations of complex privacy laws inhibit providers from exchanging information as freely as HIPAA allows. “Understanding what is and isn’t allowed would go a long way in freeing up information.”

Each successful exchange requires multiple parties to act collectively at the same time, he noted. That makes it complicated. Effective interoperability requires agreement among all of the participants on certain rules of the road. Networks are emerging to implement specific technologies and policies among groups of participants with a shared common interest.  

The report’s recommendations include several near-term actions. Current performance measures are generally process measures that are not specific and meaningful enough to inform consumer choice, said Tang. “Consumers need understandable measures that matter to choose providers, and health plans providers need clear, actionable measures to assess and improve their impact under payment reform.”

But, traditional measure developers are not adequately producing measures that matter or effectively leverage a new health IT infrastructure. The industry needs development funding for new measures, he said. The National Quality Forum is an endorser of measures but does not create measures. The organization has to wait for someone to submit measures. “The pipeline is not full of measures that are needed and that matter. This development requires funding.”

Tang said there also is a lack of transparent performance measures to assess product capabilities and sustained field performance of vendors.

The timing for these recommendations matches up with CMS Secretary Sylvia Burwell’s alternative payment models, publication of the interoperability roadmap and the dramatic changes to the information landscape in just the past two years.

“We now need public and private action. We need a coordinated blueprint for all stakeholders involved in this process to understand what has to be done by whom and when,” said Tang.

Interoperability in healthcare is complicated by the synchrony aspect, he said, “so we all have to do our part. It may happen organically but probably not fast enough for the delivery system reform timetable.”

The report recommends convening a stakeholder working summit co-led by these two major sectors—the federal government and the private sector--to act on the roadmap, get timelines defined and accelerate the pace. The summit would enumerate and define the action. Then, the HITPC could provide a venue for quarterly progress reports that help ensure coordination and accountability of the public-private efforts organized at the working summit.

Comments and questions from the rest of the committee addressed whether ONC has the authority and finances to carry out the report’s recommendations, whether one convening would be enough to serve the purpose discussed and whether the recommendations go far enough.

Tang said the report goes to Congress who does have the authority. Also, the recommendation to convene a single working summit aims to catalyze ongoing activities. He said the concern about whether one meeting would be enough is fair, a lot has changed in the last six years including EHR adoption the move towards pay-for-value and use of advanced payment models. “We’re trying to hand off from the push to the pull on the payment side. I think we’ve reached the tipping point of setting up capabilities and incentives and push them over the edge so the market can take it over.”

The committee approved the report.