The Office of the National Coordinator for Health IT (ONC) is invested in the Standards and Interoperability Framework, a collaborative initiative to develop standards for health information exchange (HIE), but the journey to completely interconnected devices will be a long one, according to the speakers of a Sept. 13 National eHealth Collaborative webinar.

“For a community to innovate, you have to have standards,“ according to David S. Muntz, principal deputy national coordinator for health IT. The guiding principles behind the ONC’s standards development efforts include the ideas that:government is a platform where innovators can create the conditions of interoperability, health information needs vary and development should occur in incremental steps. 

The ONC hopes an approach incorporating these concepts will enable a collaborative, incremental process that will enable stakeholders to develop simple tools that address common HIE challenges. These include vocabulary, content structure, transportation, security and locating services.

Stage 2 of Meaningful Use will require the testing and certification of EHRs, a condition that places a burden on vendors, who will have to meet standards, and providers, who may need to retool already implemented systems. This may seem restrictive, but it is necessary to drive healthcare forward. Approximate 75 percent of primary care visits occur after hospitalization and primary care physicians usually never have information about the hospitalization, according to Holly Miller, MD, MBA, chief medical officer for Fiskill, N.Y.-based MedAllies. This is a significant clinical problem.

EHRs create a demand for and enable the exchange of this kind of information, but disparate EHR systems do not allow it, Miller said. The vision for the future is that a patient-centered medical home will easily be able to exchange information with patients, hospitals, specialists, home health agencies and other healthcare providers.

Achieving this goal is a long and continuous process that requires cooperation, input and feedback from all stakeholders. Interoperability is a journey and not a destination, Muntz said. While meeting certain Stage 2 requirements could be made difficult by the current lack of interoperability, the ONC is not asking for perfection. Start with something good enough and let clinical practice influence evolution, Miller advised.