By Mary Butler
The new National Coordinator for Health IT, Dr. Vindell Washington, MD, plans to focus on some old issues for the healthcare industry—a lack of universal standards, limited interoperability, and the difficulty present for both providers and consumers trying to exchange and access health information in the pursuit of improved care. Washington was appointed national coordinator in August when Karen DeSalvo, MD, MPH, MSc, transitioned to another job in the Department of Health and Human Services (HHS).
In an introductory conference call with healthcare reporters in September, Washington touted the strides that providers made in the adoption of electronic health records (EHRs)—and the challenges that remain. Specifically, Washington spoke at length about the work the Office of the National Coordinator for Health IT (ONC) has left to do in terms of fostering the interoperability of EHRs and improving the exchange of health information.
During the call, Washington first responded to concerns that some physicians are still grappling with the documentation burden and effectiveness of EHRs. Washington reacted to a recent Mayo Clinic survey of 6,375 users of EHRs and computerized physician order entry who were unimpressed with the technologies, which they cited as a factor in professional burnout. He noted this response should lessen as the technology evolves, and pointed to the fact that 98 percent of hospitals and three-fourths of office-based physicians have EHR systems. He stresses the need for ONC to “pivot” to a focus on interoperability and information sharing.
ONC’s Three-Pronged Approach to Interoperability
Washington points to three areas of focus for ONC’s approach to interoperability. The first area is promoting the use of nationally recognized standards, such as the Fast Healthcare Interoperability Resources (FHIR), an interoperability protocol for electronically exchanging healthcare information overseen by Health Level Seven (HL7). The second focus area is on payment changes and reforms, like those being formed under the Medicare Access and CHIP Reauthorization Act (MACRA), such as the Merit-based Incentive Payment System (MIPS) and the Advanced Payment Models (APMs) that directly link the quality of healthcare treatment to payment.
“The third most important area is working toward cultural changes around the sharing of information. And most of our work in that space is with making sure patients know that their information should be there and should be exchanged and available when and where they need it for their care,” Washington says. “We’re focused particularly on those [three areas] because we think those are the most likely to move the industry in sharing what we all desire for the healthcare ecosystem.”
He adds that this will require collaboration with the HHS Office for Civil Rights (OCR) to make patients aware of all the data and information that belongs to them as well as the privacy and security protections provided by the law.
Advancing information sharing, Washington says, is one of his top priorities as head of ONC.
“The work we’re doing on information sharing is actually foundational work for a number of the [Obama] administration’s priorities. I think it’s important for delivery system reform, I think it’s particularly important for the Precision Medicine Initiative, and the Cancer Moonshot. And even those are longer-term strategies. The work we have to do in the short term is really around increasing this flow of information,” Washington says.
Encouragement of Private-Public Partnerships
Part of the conundrum that ONC faces in regards to interoperability is finding an approach—or approaches—that aren’t overly prescriptive. That’s why ONC created the Interoperability Standards Advisory, the model with which the agency coordinates the identification, assessment, and determination of the best available interoperability standards and implementation specifications. This has led to the release of the ONC Interoperability Roadmap, which promotes private and public sector collaboration.1
Washington says ONC applauds efforts of private organizations to move interoperability forward, including the Sequoia Project’s Carequality Interoperability Framework, and the CommonWell Health Alliance’s network of vendors and providers that use a common patient identification and records linking system to exchange patient data.
“I’d also go back to this concept that there may be different structures around information exchange based on use cases. Our general approach is to applaud the sharing of information that allows it to be available when and where patients need. We’re also particularly focused on making sure that the playing field is level, and that folks are not left out,” Washington says. “I think the thing that strikes us, though, is that there’s an opportunity to do more and to do it more broadly, and so I think that’s our focus.”
Washington says that he’d like ONC to continue being a convener—in bringing the best minds on a topic together to work on interoperability. One way ONC is doing this is by offering funding opportunities and grants to groups solving problems, such as patient identification.
Washington is optimistic about the future of emerging technologies such as “blockchain,” a technology that was first used to protect Bitcoin currency transactions, but has also proven to be helpful in securing health information exchange. ONC just wrapped up the “Blockchain Challenge,” which solicited white papers on the topic.
There has been a lot of buzz surrounding the FHIR application programming interface (API), and Washington says he’s most encouraged by the work coming out of the Argonaut Project, a collaborative project joining HL7 with several leading healthcare providers and vendors. The purpose of the Argonaut Project is to develop a first-generation API and Core Data Services specification to enable expanded information sharing for EHRs, documents, and other health information based on the FHIR specification.2
ONC has devoted considerable resources to spur innovation with standards using FHIR APIs, including $625,000 towards competitive funding opportunities in 2016. Providers and vendors can then adopt these standards to exchange patient data.
“Standards do both mature and have adjustment with more and more widespread adoption,” Washington says. “So my presumption is that as we move those vendors from demonstration projects to more widespread work, even more refinement will occur… We’re pleased that innovation is going on, and we’re watching their progress.”
 Office of the National Coordinator for Health IT. “Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure.”
 Health Level Seven. “The Argonaut Project.”
Mary Butler (firstname.lastname@example.org) is associate editor at the Journal of AHIMA.
"New ONC Chief Touts Importance of Standards Development Work"
Journal of AHIMA