ONC explains shifting approach to national health information network

The ONC's approach to building a national health information network changed over the past year. ONC chief explains why.

The Office of the National Coordinator for Health IT has backed off some of its plans to pursue a centralized national health information network in recent months. Regulators have adopted more of a public-private approach to building the network, getting non-profit groups involved and offering funding opportunities to organizations that are developing governance structures.

In the recent HIE Governance Town Hall Web conference, the National Coordinator for Health IT, Farzad Mostashari, M.D., explained in more detail why the agency took this approach to building a nationwide exchange network, and what kind of action regulators may take in the future.

During the Jan. 17 session, Mostashari said there are many different ways the country could build a nationwide exchange network. It doesn't have to involve a top-down approach. Working with private groups and local exchanges to build the infrastructure necessary to move health information could eventually lead to a unified, interoperable exchange, he said.

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"It's all good," Mostashari commented during the Town Hall conference. "There are lots of different methods for this to occur, and as long as we can get closer to this idea of information liquidity, it's good."

This diffuse approach to creating a national exchange was not the original idea. The HITECH Act, which established the meaningful use program, instructed the Office of the National Coordinator for Health IT (ONC) to establish a governance structure for the Nationwide Health Information Network (NwHIN). As part of this, the office began developing policies that would have set conditions for exchange, determined who could participate in the NwHIN, provided oversight for the network, and assessed technical standards for data exchange.

Mostashari has expressed an eagerness to build a nationwide exchange system. He has said on several occasions that the nation's health care system cannot wait any longer to engage in robust data exchange, and called for a push toward interoperability.

But after the ONC released a request for information on its proposed "Rules of the Road" for the NwHIN in May 2012, it received a cool response from industry. Most commenters said it's too early to start regulating information exchange in a top-down manner. The agency has backed away from this approach since then. The NwHIN was rebranded as the eHealth Exchange, the business operations of which are now managed by the private non-profit Healtheway Inc. The agency recently announced that it will work collaboratively with and provide funding to organizations that are creating health information exchange (HIE) governance structures.

There are lots of different methods for this to occur, and as long as we can get closer to this idea of information liquidity, it's good.

Farzad Mostashari, M.D.,
national coordinator for health IT

During the Town Hall conference, Mostashari said these kinds of activities are indicative of the agency's new approach to building a national health information network. He said the ONC is now looking to facilitate the development of information exchange capabilities throughout the health system without necessarily regulating information exchange practices or infrastructure. Mostashari said for the foreseeable future, the ONC's main HIE activities will focus on softer issues, like engaging with exchange organizations, spotlighting good practices in HIE, funding standards development initiatives and convening industry stakeholders.

"We got a lot of responses to our request for information," Mostashari said. "The consensus was that it was premature to establish a regulatory approach to governance, and we should look to other means. But it doesn't mean that we aren't going to do anything."

The ONC will retain ultimate say over whether specific governance policies are implemented in the eHealth Exchange, which includes technical standards. Other participants at the Town Hall said this is one area of HIE development the ONC should not relinquish.

Paul Wilder, vice president of product management at the New York eHealth Collaborative, which operates the state's information exchange, said variability in technical standards used by different groups is a barrier to effective data exchange. When providers use different standards it creates trust issues between them, he said. This hinders the expansion of exchange efforts and keeps data siloed.

There may be an even greater role for the government in standards development than it currently recognizes. Jeff Smith, assistant director of public policy at the College of Healthcare Information Management Executives, said part of the problem is that various electronic health record systems use different technical languages. The stage 2 meaningful use rules and certification standards begin to remedy this problem, Smith said, but standards mandated by that program primarily address lab and radiology results.

When it comes to data standards for broader records, the industry is divided, and Smith said he believes it will not settle the issues of standardization on its own.

Let us know what you think about the story; email Ed Burns, news writer, or contact @EdBurnsTT on Twitter.

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