The ONC 2016 Standards Advisory
By John Halamka, MD
ONC recently released the 2016 Standards Advisory. I think this document is more important than Meaningful Use or Certification in accelerating interoperability. Why?
Many view Meaningful Use as no longer aligned with the work we need to do for population health, care management, and alternative payment models. The more aligned activities – the Affordable Care Act (ACA), Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), and private payer risk-based payment models – require health information exchange for care coordination and quality/financial benchmarking. These programs create a business need for interoperability affecting a large percentage of an organization’s income versus Meaningful Use which at this point is a penalty program creating a small reduction in an organization’s income. When there is a business need and enabling technology, interoperability happens. The Standards Advisory gives developers, providers, and patients a list of enabling technologies, documenting their level of maturity and adoption for a given purpose. The marketplace can decide which standards are good enough, what risks to take on promising evolving standards, and which standards to retire as technology progresses.
Standards making is all about reduction of optionality – constraining the methods to represent information and transport it. To me, the Standards Advisory is exactly what government should do – convene experts to determine which standards are appropriate for purpose – then let industry decide what to implement based on the business need.
The process used to create and refine the Standards Advisory is a good one, in part based on this paper by Dixie Baker.
Importantly, the Standards Advisory is a continuous process, not one that sets a standard in the concrete of regulation/legislation that is hard to change. The advisory process is agile and likely to be more transparent than the regulation making done behind closed doors. The list of best available standards can include some standards that are not yet ready for production since the document is just a roadmap to what is available at a given time, not a regulation.
In the past, many HIT Standards Committee experts have advised ONC not to include standards like HPD (a provider directory standard) because it is not suitable for purpose in an internet connected, cloud-based, mobile friendly EHR world. Standards Committee members prefer the FHIR-based directory services that are being piloted in the Argonaut project (www.argonautproject.org). With the Standards Advisory, the debate of HPD over FHIR becomes moot since both can be listed as available standards along with descriptions of their functionality, maturity and adoption. The industry can then decide which is more fit for purpose.
As I’ve written about previously, it is my hope that CMS eliminates the Meaningful Use Stage 3 penalty, uses pay for performance incentives based on outcomes as part of MACRA to replace Meaningful Use goals, and that certification for stage 3 will rarely be done because it is a purely voluntary program. Redirecting our focus to customer requirements rather than regulatory compliance will accelerate innovation. The combination of outcomes-based performance incentives and the yearly publication of a standards advisory is a great path for the future.
John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician. This article was originally published in his blog Life as a Healthcare CIO and is reprinted here with permission.