A Work in Progress: Takeaways from the ONC Interoperability Forum

Discussing interoperability solutions

Katie Crenshaw, MPA

Over the past year, national exchange networks have become central to interoperability conversations, especially following last year’s Office of the National Coordinator for Health Information Technology (ONC) Interoperability Forum. Growth and activity from these networks remained at the forefront, especially with the ONC’s release of its draft Trusted Exchange Framework and Common Agreement (TEFCA). TEFCA recommended overall guidance for how the many networks can work to create an on-ramp to interoperability.

Like last year, there were some very clear themes at the recent Forum that will continue to drive interoperability forward into 2019, many of which align with HIMSS’s Interoperability Call to Action’s principles:

  • Demand integration between the interoperability approaches and trusted exchange frameworks for the public good
  • Educate the community to appropriately implement existing and emerging standards, data formats and use cases to ensure a comprehensive, integrated approach to care
  • Ensure stakeholder participation from across the care continuum, including patients and caregivers
  • Identify the “minimum necessary” business rules for trusted exchange to enhance care coordination
  • Standardize and adopt identity management approaches
  • Improve usability for data use to support direct care and research
RELATED: HIMSS Asks ONC to Build on Interoperability Successes in Comments on Trusted Exchange Framework

Interoperability Requires a Multi-Faceted Approach

This year’s Forum featured seven tracks to allow greater focus on the many considerations that play into how our industry advances interoperability:

  1. Infrastructure
  2. Content Interoperability
  3. Clinician Experience
  4. Interoperability for Research
  5. Security
  6. Measurement
  7. Patient Matching

These tracks allowed for a deeper discussion of the many components that must be considered to make an interoperable solution work. As the dialogue across these tracks emphasized, the healthcare community must go beyond the technical components for implementation when attempting to solve interoperability challenges, and consider the trust frameworks, governance structures, workflows and business value of exchange in order to make it meaningful to the end user.

Is There One Path to Interoperability?

Many conversations centered on the application of FHIR®-based open application program interfaces (APIs). Despite this attention, attendees made two clear points about this standard that are important to remember as advances continue with the FHIR® standard. First, many of its current applications are still myopic and designed for highly specific, intra-organization needs. We have a ways to go to see implementations that are inter-organizational and scalable to meet the many needs for exchange, though efforts are underway. Second, there are many great use cases for FHIR®, but other modes of exchange still make sense for a number of scenarios. Direct messaging has a clear role in provider communications and many use cases benefit from Integrating Healthcare Enterprise (IHE) profiles for query needs. Attendees highlighted that we will never reach a point where all stakeholders are leveraging the same standard. Therefore, we shouldn’t get held up on getting everyone to one technical standard, and instead focus on developing the trust and governance needed for exchange.

A Broader Landscape for Interoperability Use Cases

In addition to the traditional conversations around provider use cases, a number of new stakeholder groups and use cases were also highlighted. Over the past year, the HL7 DaVinci Project and ONC Provider Payer (P2) FHIR Task Force are developing new use cases to facilitate payer-provider exchange. This work was highlighted at the Forum, and implementation guides are expected in the next few weeks.

Consumers and caregivers were center stage with demonstrations on new apps and calls for stronger engagement with caregivers as a stakeholder group. Long-term and post-acute care, research needs and public health also joined the conversation sharing how they benefit from improved interoperability.

As interoperability perspectives broaden, it is clear that the use cases for interoperability also grow beyond point-to-point exchange. It was emphasized that there is great potential for innovation when standards are appropriately implemented and trust is defined across these disparate groups.

A Call to Action

Discussions clearly hit on all six of principles outlined in HIMSS’s Interoperability Call to Action. You could see progress in these areas, but also a lot of work that still must be done. We are seeing continued alignment of the national and regional exchange networks and a growing number of stakeholders added to the conversation. More and more, we are realizing the conversation needs to move beyond the technical and consider the governance requirements for exchange.

The industry still has a ways to go in implementing standards in a scalable method, adopting standardized identity management solutions and ensuring the data exchanged is meaningful and useful for care and research purposes. However, continuing conversations on these topics is an important step in driving interoperability forward.

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