Interoperability from a DC point of view

December 20, 2018 By Corey Spears

Recently, I had the opportunity to attend the Office of the National Coordinator for Healthcare IT (ONC) Annual Meeting. I always enjoy attending these events as they tend to act as a reunion of healthcare IT leaders and are filled with lots of useful discussions and information. It’s a great way to gather with others in the industry who are trying to move forward the valuable work of improving interoperability.

Topics discussed during this meeting ranged from national regulatory rules to local interoperability projects and everything in between. Since this was an ONC event, regulatory topics took center stage.

Regulatory purgatory?

Before the event, it was my hope that we would be graced with two work products from the ONC mandated by the 21st Century Cures Act so that we could then discuss them at the meeting. Unfortunately, we only received one, the draft “Strategy on Reducing Burden Relating to the Use of Health IT and EHRs.”

Reducing burden

As the name of the document uses “Strategy” in the title, this is a pretty high level document meant to set the direction of upcoming tactical moves with the goal of reducing the burden of complying with the Medicare Access and CHIP Reauthorization Act (which replaced the previously named Meaningful Use program). Even though the focus of this document is not directly in the scope of my work, there are some good things in it and the goals are certainly laudable. It addresses areas like clinical documentation, EHR usability, EHR program reporting, and public health reporting. The parts that I will be paying particular attention to are those regarding APIs. It is likely that I will be submitting some comments on this draft, and I would recommend everyone that has an interest in this area do so as well. The public comment period closes on January 29, 2019. There are several mentions of the term Open APIs, which I have a feeling will be better defined in the other rule that we did receive, a proposed rule on information blocking.

Information blocking

The members of the Department of Health and Human Services (HHS) and ONC are very quiet on just what will be in the rule that addresses information blocking. This is, of course, in compliance with government rules about releasing information before it has officially been published. However, there was some discussion about the overall approach or attitude that the department is taking on the topic. Eric Hargan, the Deputy Secretary for HHS, stated that they believed it was up to the government to define the “what,” and up to the industry to define the “how.” He also stated that they were careful to take a practical approach and not apply a heavy hand in regulations. It will be interesting to see how that plays out. We certainly do not want regulations that are too prescriptive or proscriptive or we might end up like the situation we have with HIPAA requiring the use of X12 for financial communications between providers and payers, with the issue being that the industry is mandated to use 90s-style financial messages by clinical systems. Technology has changed and there are a lot better options for this type of interoperability. There are some ways around it, but the requirement creates an unnatural solution. We want to avoid technology “lock-in” while providing a baseline to improve interoperability. The proposed rule was handed to the Office of Management and Budget (OMB) back on September 17, 2018. The OMB is supposed to complete their work within 90 days of receipt, which was December 16. So, we should see it at any moment.[CS1]

During a panel discussion at the ONC meeting, I asked Steve Posnack, Executive Director at ONC, whether this rule would change EHR technology certification requirements. In response, Steve gave a beautiful and artfully crafted non-answer, which of course he had to do as he cannot release any information about the rule before it is out. It was a well-stated response. If I were to read between the lines, however, I have a feeling we are going to see some recommended changes in the certification requirements. To what degree, we will have to see. The 21st Century Cures Act states that certified technology publish “application programming interfaces and allows health information from such technology to be accessed, exchanged, and used without special effort through the use of application programming interfaces or successor technology or standards, as provided for under applicable law, including providing access to all data elements of a patient’s electronic health record to the extent permissible under applicable privacy laws.” It will be interesting to see how ONC has decided to define that.

Fewer FHIR puns to extinguish

While I heard a couple of puns around FHIR, there were not nearly as many as I have heard in previous meetings. I think this is in correlation to where FHIR sits on the hype curve. During another panel discussion, it was stated by one panel member that FHIR is past the peak of the hype curve. Another panel member thought that FHIR might be impervious to the hype cycle’s trough of disillusionment. Personally, I think there are still a lot of lessons to learn about FHIR, and the industry will eventually become aware that there will still be a need to manage these interfaces to create a maintainable interoperability ecosystem. During one of the sessions a quick straw poll was taken in the room to gauge where the challenges are to using FHIR. The challenges that were most prominent were technical knowledge and finding trading partners, which brings me to my next topic.

The Da Vinci code

Another topic that was prominently showcased was improving interoperability between providers and payers. This includes improving coverage discovery, prior authorization, claims attachments and more. As I mentioned earlier in this post, much of these transactions have to be completed using X12 at some point in the transaction flow between provider and payer. However, there are now a couple of efforts underway to find solutions using FHIR. The two efforts are the Da Vinci project, which is a “a private sector initiative that addresses the needs of the Value Based Care Community,” and the ONC P2 FHIR Task Force (P2 = Payer + Provider). The Da Vinci project is focused on creating FHIR implementation guides to address the transactions between providers and payers. The ONC P2 FHIR Task Force is focused on how to make those solutions scalable nationwide. When these efforts mature and the work products start to get used, there won’t be any problem finding a trading partner. I could create a whole blog just about these two efforts, which is what I just might o.

To learn more about what Infor is doing with FHIR, visit our website.

-Corey Spears, Director of Healthcare Interoperability Standards, Infor

Filed Under
  • Healthcare
  • Healthcare
  • Cloverleaf Integration Suite for clinical interoperability
  • North America
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