Sunday, February 1, 2015

The Death of Meaningful Use: ONC's Interoperability Roadmap

ONC's vision of the health IT ecosystem as a Learning Health System

This past week the ONC released it's vision for health IT interoperability in a draft 1.0 document entitled "A Shared Nationwide Interoperability Roadmap."  There were a few items that caught my attention in the 166-page document, most notably the following words, nestled deep in the middle of page 50:
"This Roadmap shifts the nation’s focus from meaningfully using specific technologies with specific features to working together as a nation to achieve the outcomes desired from interoperability and a learning health system."
Granted, this is a draft document, but that sure sounds like an official death knell to meaningful use (MU) as we know it.

From my perspective, MU has done quite a bit of good to raise awareness of the importance of health IT to help us speak the same language so we can get the right information to the right person at the right time to make the right decision (sound familiar?).

However, the accompanying MU certification process has bogged-down health systems and stifled innovation through timed incentives and disincentives that has resulted in hospitals scurrying to claim their entitlements at the expense of thoughtful and measured health IT progress.

So it's with great excitement that I read the ONC's draft document that focuses this effort on public-private collaboration to start solving the thorniest issues we've faced, including policies and technologies to promote streamlined and robust interoperability.

The document also touched on a subject near and dear to my heart (p. 10):
"Given the increasing volume of mobile technology usage among consumers and across the care delivery system, approaches to enable "send, receive, find and use" in the near-term must support the flow of electronic health information across both institutional and mobile-based technologies. This means traditional approaches to health IT interoperability will need to become more agile and leverage the experience of modular consumer applications, such as those created by Facebook, Amazon and Apple. These secure, but simple architectures have enabled an ecosystem of applications that allow users to engage with electronic health information across a variety of different platforms and devices and open opportunities for entrepreneurial third parties to thrive."
Through the SMART on FHIR framework, this will soon be a reality in health care.  I'm excited to be leading the initiative at Duke to be the first Epic-based hospital with a functional implementation of SMART.

Furthermore, the document highlights the importance of facilitating the incorporation of patient-generated health data into our EHRs (p. 46):
"There needs to be a greater focus on incorporating patient-generated health data and ensuring the availability of tools for individuals to use this information to manage their health and make more informed health-related decisions."
Our experience with Apple's HealthKit here at Duke has shown us that this idea is a reality, today.  It's never been easier to get high-quality patient data integrated directly into our clinical systems so that providers can quickly act to improve patient outcomes.

This type of technology is the essence of a Learning Health System, which is emphasis of the ONC's draft document.  2015 is going to be an exciting year for healthcare technology and interoperability.

RIP, Meaningful Use.

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