How the ONC is Working Toward Interoperability


When discussing the country's progress toward interoperability, ONC's chief science officer believes it is first important to clarify what interoperability really means.

"Interoperability is the ability to exchange information, and then to use the information that has been exchanged," says Doug Fridsma, MD, PhD. "I think that's a very powerful definition because it says interoperability isn't an abstract concept — it has to be grounded in a thing you're trying to accomplish."

At the ONC, Dr. Fridsma and his colleagues are working with industry stakeholders to develop interoperability standards that allow for the purposeful exchange of information that would result in improved care delivery and better operational efficiency, as well as meet meaningful use and other regulatory requirements. "Our goal at the ONC is to bring together people who have common problems and come up with solutions they can share," says Dr. Fridsma. "And so we use the standards of interoperability framework as a way of convening those folks."

One of the first projects the ONC used to bring stakeholders together to address a common roadblock was the Direct project, which enables authenticated, secured transmissions of electronic health data over the Internet. Thirty-two electronic health record vendors and 45 health information exchange software systems and health information exchange organizations currently support Direct.

"Direct was one of the first prototypes we used in terms of convening the communities, bringing them together, and having them help us find a solution that would work," says Dr. Fridsma. Since then, the ONC has embarked on similar projects to find solutions for the industry's health information exchange challenges. Currently, the ONC has 17 initiatives relying on the input of more than 2,900 industry professionals who have attended about 2,200 meetings over the past three years.

One of the standards the ONC is working on is a provider directory standard to facilitate the exchange of data between disparate organizations, so one provider can more easily find the intended recipient at the other organization. "Obviously, if you want to send someone information, knowing where to send it becomes important," says Dr. Fridsma. "And where do you find it? There's not really a Yellow Pages out there for this."

Specifications developed in the past have revolved around the idea that the government would create a centralized national provider directory, which Dr. Fridsma says is impractical for a country of this size. "So we've created what we call a federated model that allows different networks to be able to share directory information and be able to query one directory and then send that out to other directories so that you can find a particular provider," he says.

Going forward, a main component of the ONC's interoperability strategy is to find solutions that help providers attest to meaningful use. The ONC also plans to "work with our health IT policy committee and the standards committee to make sure we expand our portfolio to take advantage of things like accountable care organizations, healthcare reform, value-based purchasing, those sorts of things," says Dr. Fridsma.

Additionally, the ONC is working to keep its standards current as more technologies come onto the market. At HIMSS' annual conference last week in Orlando, the ONC demonstrated HL7 Fast Healthcare Interoperability Resources, or FHIR, a new standard that allows for easier development of application programming interfaces to foster the creation of interoperable technology. "It's sort of a standardized plug to be able to get information in and out of an EHR," says Dr. Fridsma. "And it's demonstrated some tremendous successes in terms of having external developers who create apps to be able to plug them in to existing EHRs."

The ONC plans to continue to work closely with the health IT community to identify the technologies that help organizations achieve their interoperability goals, allowing both available technology and provider needs to influence governmental requirements such as meaningful use stage 3 and help keep interoperability standards responsive to new needs.

While Dr. Fridsma is optimistic about the results of current ONC efforts to get providers the interoperability they need, he recognizes there is a long way to go. "What we're trying to do, if it was easy, people would have done it already," he says.

More Articles on Interoperability:

6 Considerations for Choosing Clinical Technologies
HIMSS Unveils Continuity of Care Maturity Model
Epic, Walgreens, UnitedHealth, Kaiser Partner to Share Patient Data


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