Health IT Policy Committee Hears Reports on EHR Attestations and Interoperability Recommendations
At its meeting on Tuesday, December 9. 2014, the Health IT Policy Committee discussed several issues, including reports from the Centers for Medicare & Medicaid Services (CMS) on the 2014 EHR Incentive Program attestation numbers and draft recommendations from the Interoperability Workgroup on what it would like to put forward for inclusion in the Interoperability Roadmap Version 1.0, that is expected to be published by the Office of the National Coordinator for Health IT (ONC) in January 2015.
CMS’ reported how 2014 attestation data have improved from November to December:
For eligible hospitals, only about 35 percent of those eligible had attested to Stage 2 by December 1, which is up from about 18 percent as of November 1. There were 16,455 eligible physicians that have attested to Stage 2, which is a significant increase from the 11, 478 reported as of November 1, but still only about 4 percent of eligible professionals.
Overall, these numbers reinforce HIMSS’ work advocating for the FLEX-IT Act (HR 5481), which would reduce the reporting period for 2015 from a full-year to 90 days for all eligible providers. Please visit our Legislative Action Center for more information about the bill and how to express your support for the bill.
In addition, the Interoperability Workgroup finalized its recommendations for ONC on the Interoperability Roadmap. The Committee agreed to put forward five recommendations related to the Interoperability Roadmap:
This recommendation emphasizes coordinated architecture and public application program interfaces (APIs). The key elements that the Committee wanted to highlight are: loosely coupled architecture connecting disparate Data Sharing Arrangements; the public API approach which has a technical component (data-level and document-level access) and a policy component (terms for accessing APIs across entities).
The Committee did explicitly mention Fast Healthcare Interoperability Resources (FHIR) as the current best candidate for the public API.
Identify specific market motivating implementation actions that the Federal Government could/should/will take to promote interoperability
The Committee believes that the Roadmap should create a framework for describing federal orchestration of the many levers that it has at its disposal. They recommend aligning the Roadmap with the JASON Task Force report which provides a framework for escalating government actions to motivate the market, such as greater transparency, authoritative guidance, aligning incentives to stimulate the use of public APIs, and requiring federal healthcare entities to adopt public APIs in their technology procurement activities and day-to-day market interactions.
The Roadmap should define meaningful measures of interoperability status and progress
The Committee believes each milestone should be tied to a measure, and the measurement focus should be on outcomes with a decreased emphasis on transactional and process measures. The Committee did note that this is a highly complex area.
The Roadmap, if it is to be a “Roadmap”, should be a prescriptive document
There is a need to decide whether the level of detail in the Roadmap is directional or specific. If ONC chooses the specific approach, they would need to propose narrow tactics and highlight trade-offs. The Committee also believes that a glide path should be outlined for stakeholders who will need to make changes to align with the selected direction.
The Committee also put forward the idea that ONC will need to decide whether the Roadmap is aspirational (i.e., an indication of where the Federal Government would like the industry to go) or directive (i.e., will be promoted and enforced through specific government actions – incentives, regulations, market actions).
Map actions to actors
The Roadmap should explicitly call out the actors who will be expected to implement the various actions/milestones outlined in the Roadmap. This will help coordinate actions across the ecosystem and help reduce duplicate efforts.
The Committee also discussed additional ideas they are proposing to add to the Roadmap, including outlining steps to address orders as this area has a big gap in vocabularies. Also, the Roadmap should make clear that existing approaches will continue to be refined to serve ongoing needs and to fill specific gaps, such as registries, National Council for Prescription Drug Programs, and XCA/XDS.