ONC to Tackle Interoperability in 2015 As Congress Requires New Certified EHR Tech to Include Interoperability and Direct De-Certification of Current Systems That “Proactively Block the Sharing of Information.”

by Leonardo M. Tamburello

Before the ubiquity of the internet, it was at best cumbersome and at worst impossible for computers using different operating systems or applications to share information or files with each other. The result was a balkanized world where Macintoshes couldn’t talk to IBM PCs and where venerable WordPerfect users could not share word processing documents with the young upstarts who adopted Microsoft Word. Although there remain some outliers, for the vast majority of users these issues have largely evaporated as technologies have coalesced to share data seamlessly across multiple platforms and applications today.

Unfortunately, most EHR systems are stuck in the virtual past, unable (sometimes by design) to communicate with their brethren in what has become known as “information blocking.” As previously discussed on this blog, the sharing of patient data among allied health professionals, insurers and researchers is fundamental to the ONC’s “10 Year Vision to Achieve An Interoperable Health IT Infrastructure.”

Just as EHR incentives transform into Medicaid penalties in 2015 for providers who fail to demonstrate appropriate Meaningful Use, the Office of National Coordinator for Health Information Technology (ONC) has been directed to only certify EHR systems “that clearly meet current meaningful use program standards and that do not block health information exchange.” As for current EHR systems, “ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments [certified EHR technology (]CEHRT[)], and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use.” (emphasis added).

Before the end of March, ONC is to submit a detailed report to Congress on the extent of the EHR information blocking problem which includes an estimate of the number of vendors or eligible hospitals or providers that block information, along with a strategy addressing the issue.  The first hints from ONC may come from its 2015 Annual Meeting scheduled for February 2-3, 2015 in Washington, D.C. Also sometime in 2015, the Health IT Policy Committee is to report on the technical, operational, financial and other barriers to interoperability and the role of certification in advancing or hindering interoperability across various providers. Presumably, these reports will strongly influence ONC’s Standards and Interoperability (S&I) Framework which remains in its nascent stage and perhaps even Stage 3 Meaningful Use requirements which remain undefined.

Noticeably absent from this Congressional mandate is any explicit directive that either ONC or the Health IT Policy Committee consider the privacy and/or security issues created by the widespread sharing of otherwise proprietary data that is called for by interoperability on the scale envisioned by ONC. Any discussion of interoperability must include consideration of the privacy and security implications created by even greater proliferation of healthcare data. This is particularly relevant given the increasingly specific targeting of HIT information by data thieves along with plans by the Department of Health and Human Services Office for Civil Rights to conduct audits of 200 covered entities and up to 400 business associates for HIPAA compliance in 2015.