Toward Healthcare Interoperability

1. Toward Healthcare Interoperability LeRoy Jones, Sr. Advisor Office of the National Coordinator for Health Information Technology

2. Disclaimer • This presentation is meant to summarize the work the Office of the National Coordinator for Health Information Technology (ONC). In some areas, the presentation and/or the presenter may amplify elements of this work based on observations of ongoing discussions within ONC. None of the information presented here is meant to obligate the Federal Government to follow any particular course of action, nor to espouse an official position of the Federal Government, for the present or in the future.

3. Healthcare in America Is a Behemoth • Caregivers • Organized care-delivery entities • Local / State / National authorities • Health Services (e.g. – freestanding labs) • Public health surveillance • Medical research • Regional / socioeconomic care disparities • Payers • Employers • Pharmaceutical industry • HIT – vendors, infrastructure, integration, solutions, tools • Electronic and paper-based information workflow • Regional information sharing groups • Standards & Interoperability groups

4. = + Patients / Consumers Healthcare System Good Outcomes x x Bad Outcomes = + Electronic Information Patients / Consumers Healthcare System Paper-based Information Understanding The Equations

5. = x x Electronic Information Good Outcomes Paper-based Information Bad Outcomes Understanding The Equations

6. Current National Landscape THE FED Public Health Multi-stakeholder Interoperability Silo Interoperability Community Data Sharing Standards

7. The President’s Vision • Medical information follows the consumer so they are at the center of their care • Consumers choose physicians and hospitals based on clinical performance results • Clinicians have complete patient history, computerized ordering and electronic reminders • Quality initiatives measure performance and drive quality-based competition • Public health and bioterrorism surveillance are seamlessly integrated into care • Clinical research is accelerated and post-marketing surveillance expanded

8. July 21, 2004 Strategic Framework • Goal 1: Inform Clinical Practice • Incentivize Electronic Health Record (EHR) adoption • Reduce risk of EHR investment • Promote EHR diffusion in rural and underserved areas • Goal 2: Interconnect Clinicians • Foster regional collaborations • Develop a national health information network • Coordinate federal health information systems • Goal 3: Personalize Care • Encourage use of Personal Health Records (PHR) • Enhance informed consumer choice • Promote use of tele-health systems • Goal 4: Improve Population Health • Unify public health surveillance architectures • Streamline quality and health status monitoring • Accelerate research and dissemination of evidence into practice

9. Envisioned National Landscape THE FED Public Health utilizing a “NHIN” Multi-community Interoperability ala a “NHIN” Community Data Sharing ala “RHIOs / a NHIN” Incentives Standards codified in a “NHIN”

10. workflow integration • competition suppression • policy/statutory satisfaction • interface accommodation • operational feasibility • switching costs & general economic feasibility • assurance of success • syntactic equivalence • semantic equivalence • data matching & integration • underlying data generation function (context) • custodial responsibilities (e.g. – privacy & security) • enterprise compatibility • maintainability • scalability / capacity • upgrade strategy • service levels • functional synergy • forward / backward compatibility • innovation accommodation Interoperability Considerations E N T I T Y 1 E N T I T Y 2 Business Business Information / Data Information / Data Application Application Technology Technology

11. RFI – Overview • Purpose: Obtain comments on how best to build, operate, and sustain the concept of a National Health Information Network for widespread interoperability and health information exchange. • Questions: 24 questions in six categories: • General • Organization & Business Framework • Management & Operational Considerations • Standards & Policies to Achieve Interoperability • Financial, Regulatory Incentives & Legal Considerations • Others-Technical Architecture • Response: Over 500 responses from all quarters of industry, and more than 15 federal agencies desiring to participate in analysis

12. Other medical data (e.g. – medical devices) Harmonized Standards Orchestrated Data Exchange Standards Good Outcomes Incentivized Adoption Our Focus: The Electronic Health Record (EHR) Certified EHR

13. EHRs • There is no accepted definition of EHR software that informs buyers of what functionality should be expected • There is little ability to switch vendors once a product has been selected • Products across vendors are largely unable to exchange information

14. Certified EHRs • A minimum functional set defines a baseline product • Certification ensures interoperability through a NHIN • Consumers have a pre-qualified set of vendors to consider for patronage • Vendors may capitalize on interoperability features in products based on minimal product definition Certified EHR

15. Standards • Various standards authorities are publishing standards for different elements of healthcare • Adoption is varied, with vendors pledging support, but often falling short of real utility • Niche market has developed in systems integration due to inconsistent implementation of standards, or disregard of them • The business case for incurring switching costs is often muddled at best: short-term narrow objectives are enemy of long-term, broad interoperability goals Standard 1 Standard 2

16. Standards Harmonized Standards • Appropriate and mature standards used for healthcare use cases • Gaps in standards filled in by qualified groups • Overlapping standards resolved by market appropriateness and resolution expressed in certification

17. Data Exchange • There is a recognition that standards are necessary but insufficient for interoperability • There are few examples of working multi-enterprise, multi-organization data exchange models, though interest is high • There is no dominant design • Several in-house debates have arisen and slowed progress on a unifying strategy (e.g., central data storage, universal identifiers) • Enterprise variations in areas like security pose challenges to migration to unified operational models

18. Orchestrated Data Exchange • Information flow via a nationwide health information network • Product certification that includes interoperability through a NHIN • Implementation and testing coordinated on a local level

19. Harmonized Standards Certified EHR Standards Orchestrated Data Exchange Migration to Interoperability Vendors SDOs NC NC NC RHIOs Interoperability Health Enterprises NC = National Coordination

20. Harmonized Standards Certified EHR Standards Orchestrated Data Exchange Migration to Interoperability Vendors SDOs NC NC NC RHIOs Interoperability Health Enterprises NC = National Coordination

21. Harmonized Standards Certified EHR Standards Orchestrated Data Exchange Migration to Interoperability Vendors SDOs RHIOs Health Enterprises Interoperability NC = National Coordination

22. Major Tenets • Public / Private ownership of the problem and the solution • Leverage federal buying power, employment power, and market power to bring about change • Take advantage of best practices and build upon existing foundations • Focus on actions, decisions, and measurable forward progress

23. Thank you for your attention! leroy.jones@hhs.gov http://www.hhs.gov/healthit/ For copies of this presentation, contact mari.johnson@hhs.gov