ONC Webinar Reveals Details of Data Exchange Projects

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In a webinar hosted by the National eHealth Collaborative (NeHC) last week, the Office of the National Coordinator of Health IT (ONC) revealed some details about the interoperability work it recently delegated to two outside entities, the New York eHealth Collaborative (NYeC) and DirectTrust, the first two recipients of grants under ONC's Exemplar HIE Governance Program.

In collaboration with the NeHC, a nonprofit entity that educates the industry about the agency's activities, ONC also has established a health information exchange (HIE) forum for HIE governing entities. This forum, which will hold its next meeting May 29, is designed to help HIEs share best practices, discuss common challenges, and address them together, while identifying areas where new solutions are needed.

NYeC is the driving force behind the EHR/HIE Interoperability Work Group (IWG), a consortium of 19 states, 20 EHR vendors and 22 HIE vendors that are collaborating on practical solutions to advance interoperability. Together with Healtheway, the nonprofit entity that operates the eHealth Exchange (successor to the Nationwide Health Information Network Exchange), IWG has contracted with the Certification Commission for Health IT (CCHIT) to test and certify EHRs and HIEs for interoperability.

[ Fed up with compliance roadblocks? Read Interoperability Depends On EHR Vendors: AHA. ]

Under terms of its ONC grant, NYeC agreed to perform certain tasks related to provider directories, an essential component of secure clinical messaging, and patient matching, which is needed for query-based information exchange.

Specifically, NYeC will conduct pilot projects showing methods to optimize use of a provider directory during exchanges of messages that use the Direct Project secure messaging protocol. And it will conduct a learning forum to identify and improve patient-matching practices when sharing clinical information within and across communities. Both of these activities will take place from July to December 2013.

John Donnelly, president of InterPro Solutions, is leading NYeC's initiative. In the webinar, he explained that his task force is recruiting five to seven participants for the provider directory pilots. These participants will be states and vendors that may or may not be IWG members, he said. They will test various models for querying provider directories to support exchange of Direct messages both between EHRs and health information service providers (HISPs) and between HISPs. HISPs are the entities that convey Direct messages between trusted healthcare parties.

The results of these pilots, Donnelly noted, will be fed back to ONC and incorporated into IWG's Direct Specifications Implementation Guide by February 2014.

Seven to 12 participants, including states, regional HIEs and vendors, will be recruited for a learning forum that will develop a best practices guide on patient-matching practices for electronic record query and retrieval. The forum's goals are to improve matching algorithms, set and measure matching thresholds, and improve data quality for matching fields.

DirectTrust is accrediting HISPs and registration and certification authorities in conjunction with the Electronic Healthcare Network Accreditation Commission (EHNAC). Its ultimate goal is to enable HISPs to exchange information freely without having to create costly, time-consuming trust agreements with one another.

ONC gave DirectTrust a grant to support that work. So far, DirectTrust, which includes about 40 HISPs, HIEs and other entities, has accredited one HISP, and has accepted seven other HISPs and registration authorities as candidates for accreditation, according to DirectTrust president and CEO David Kibbe.

Farzad Mostashari, the national coordinator of health IT, emphasized the high priority that his office places on accelerating the expansion of interoperability among health IT systems across the nation. Noting that software vendors are working hard to build data exchange capabilities into their EHRs for Meaningful Use stage 2, he said that healthcare reform might also improve the business case for health information exchanges (HIEs) by making it "more profitable to share information than not to share information."

Meanwhile, ONC continues to guide the private sector's efforts to increase interoperability. The agency recently released a "framework for trusted health information exchange" that conveys what it regards as model "rules of the road."

Alluding to ONC's effort last year -- later retracted -- to start a rulemaking process for national HIE governance, Mostashari recalled that he was persuaded by commenters who said, "'don't do rulemaking until you know what the problems are that you're trying to solve and don't freeze the market just as we're trying to get some interoperability going here.'" Consequently, ONC is trying to find out what's going on in the market and what works and doesn't work in interoperability.

However, he added, ONC will revisit the regulatory approach to HIE governance if necessary. "If the evidence shows that we need rulemaking to do that, we're not going to be averse to doing that, if that's what it takes," he stated.