ONC Responds to HIE Criticism with Grants

The federal Office of the National Coordinator (ONC) for Health Information Technology, stung by a negative report on health informati on exchanges (HIEs) last month, responded last week, handing out nearly a half million dollars to spur private efforts in the area.

ONC awarded DirectTrust and the EHR/HIE Interoperability Workgroup (IWG)each Exemplar HIE Governance Program Cooperative Agreements to continue to support their work advancing the governance of health information exchange.

"We will work closely with each of these entities and their partners to develop policies, interoperability requirements, and business practices that align with national priorities, overcome interoperability challenges, and reduce implementation costs," says Claudia Williams, director of ONC's State Health Information Exchange Program.

Williams says the grants provide ONC the opportunity to urge its many partners, including providers, vendors, and HIE initiatives across the nation, to participate in fledgling HIE governance initiatives, now that the ONC has decided not to take the levers of such governance for itself—at least for now.

ONC's support for DirectTrust will fund continued development and implementation of its accreditation program for health information service providers (designated as HISPs), developed in partnership with the Electronic Healthcare Network Accreditation Commission (EHNAC), a nonprofit standards development organization and accrediting body.

"The purpose of DirectTrust is to help support Directed Exchange," says David Kibbe, MD, president and CEO of DirectTrust. "Directed Exchange in turn is a means of inter-vendor, standards-based exchange of health information that is designed to overcome the barriers of organization and IT platforms that have really significantly impeded interoperability and exchanges of health information for as long as most of us have been working in this field."

Directed Exchange, when built into electronic medical record software as early as this fall, is a requirement of stage 2 of the federal government's Meaningful Use protocols for healthcare providers.

"Directed Exchange is designed to be as easy as email," Kibbe says. "That's because Directed Exchange really is email. It uses protocols and specifications from email very similar to what we all use with Gmail or with Yahoo mail to send messages and to attach attachments, and move data to where we want to between known parties.

"But there's a big difference, and that is that in healthcare, when health information is being exchanged, we need it to be private, we need it to be secure, and we need to have trust in the identity of the persons or organizations with whom the information is exchanged, whether it's going between one doctor to another, or a doctor to a nurse, or from a nurse to a patient,"Kibbe adds.

The new ONC grant is a key enabler to EHNAC's accreditation program to certify "trusted agents," who act on behalf of Direct Exchange users to assure that a layer of security is in place, and that the parties providing those services are held accountable over time, Kibbe says. So far, a dozen HISPs and certificate authorities are undergoing accreditation, he adds.

"Health Internet service provider A serves a group of providers, and health Internet service provider B, who services another group, need to be able to exchange information and to trust one another with respect to privacy, security, trust, and identity," Kibbe says. "Contracting between HISP A and HISP B with legal contracts is not a very efficient way to do that at all. As a matter of fact, it probably wouldn't work at scale. Accreditation is a means of allowing those parties to voluntarily take a test and then achieve recognition and a seal of approval with respect to having passed that test, and having kept their security and trust and identity procedures up to date."

Continuing federal efforts to promote health information exchange came under fire in the March 13 issue of The Journal of the American Medical Association in "Putting Health IT on the Path to Success," an article co-authored by William A. Yasnoff, MD, president of the Health Record Banking Alliance. From 2002 to 2006, Yasnoff was HHS senior advisor on what was then known as the National Health Information Infrastructure.

In an email to HealthLeaders commenting on last week's ONC HIE grant announcements, Yasnoff said ONC's latest efforts are misguided.

"Governance of HIEs will continue to be problematic as long as patients do not control their own data," Yasnoff says. "Only patients through their consent can overcome the complex tangle of state and federal legal requirements about the use and transport of medical data."

Continuing efforts to accomplish this through "governance" without patient consent will never work, Yasnoff says. "We must give up our paradigm of trying to automate the current (and ineffective) process of contacting other providers to get missing records. This approach does not, and cannot, get us to a system that ensures the availability of comprehensive electronic patient information when and where needed—as ONC itself admitted in their 3/6/13 RFI."

ONC's March 6 request for information seeks public input about a variety of policies that will strengthen the business case for electronic exchange across providers to ensure that patients' health information will follow them seamlessly and securely wherever they access care. Public comments on the RFI are due April 21.