The Nationwide Interoperability Plan (and how you can help)

The Nationwide Interoperability Plan (and how you can help)

You may have heard about the 10-year vision plan that the Office of the National Coordinator for Health Information Technology (ONC) laid out in 2014. In this plan, the ONC envisions a “health IT ecosystem” in which the efficient and effective sharing of electronic health information results in an empowered, healthier population, better clinical decision-making and smarter spending.

The ONC has been collaborating with federal, state and private partners to develop the Roadmap. This includes 25 federal partners, 90 individuals from 38 states, and an advisory committee with 167 representatives from 140 private and public organizations. In 2015, the ONC shared with us the Roadmap and guiding principles for achieving the 10-year vision plan, along with 3-, 6- and 10-year agendas. Why is this plan important? How will it succeed, and more importantly, what can we do to help?

The importance of achieving interoperability

The nation has made dramatic progress thus far in building the foundation for interoperability. More than half of office-based professionals, along with 80 percent of hospitals, are now meaningfully using electronic health records. Half of hospitals are able to search beyond their own system for patient information, and all 50 states have some form of electronic health information exchange to support care (Sources: ONC and However, the current health care system still consists of fragmented care and individual silos of data, along with competitive pressures that discourage abandoning the status quo. We still have a long way to go to achieve nationwide interoperability. But if we imagine it, what would this interoperable health IT ecosystem look like?

  • Individuals, families and health care providers could find, send, receive and use electronic health information in a secure, reliable and timely way.
  • Patients and physicians will be empowered to make better use of health data to support decision-making.
  • The IT infrastructure will support a value-based payment system that rewards the quality of care, rather than the quantity of care.
  • A “learning health system” will result in lower health care costs, improved population health and ongoing scientific advancements.

Rules and Guiding Principles of the Plan

The ONC and its collaborative partners have developed some rules of engagement to guide the 10-year process, including: how to support and govern the effort; privacy and security considerations; core technical standards; certification, and testing procedures. They have also developed critical action steps and milestones for each year of the plan. The guiding principles for nationwide interoperability include:

  • Built from existing health IT infrastructure
  • Baseline interoperability, with variables to meet specific needs or scenarios
  • Built to empower individuals
  • Dictated by market demands
  • Built from simple to complex
  • Created in modular fashion, with connectivity over time
  • Accommodating to various adoption levels
  • Focused on value provided
  • Providing privacy and security protection
  • Scalable and universally accessible

3-year, 6-year and 10-year agenda

The federal health IT strategic plan includes overall goals of collecting, sharing and using health information. The critical actions for the first three years of the plan include getting existing communities to agree on a governing process, as well as establishing rules for coordinated efforts. During this time, the ONC will publish and update a list of the best available standards for interoperability, including specifications for querying a common clinical data set, which will then be released to the public and tested for content and semantics. The ONC will also clearly define privacy and security drivers required to enable interoperability. Eligible health care institutions will also continue to adopt electronic health records and achieve meaningful use stage 3 certifications during this period, while consumers will expand the use of online portals for accessing health information.

The six-year agenda will allow individuals to become even more active participants in their health management, integrating self-generated data into apps and tools. Care providers will begin aggregating and trending more information as they receive health data from multiple sources. Value-based payment will become more prevalent during this time period, allowing for new standards of measuring clinical quality. Stakeholders will help refine and improve the quality of the standards while closing care gaps to streamline clinicians’ workflow.

By year 10, the interoperability will allow for a more connected health care system, improving information sharing, and allowing individuals to better manage their own health. This health IT ecosystem will generate more information at the point of care. Through a more standardized data collection, aggregation and analysis, physicians will be able to improve patient outcomes through clinical decision support. Public health will also improve through surveillance, clinical trial recruitment, research, data collection and analysis to prevent and control public health threats and manage diseases. In supporting better health for all, the 10-year interoperability plan will truly make our nation’s health system a learning health system.

How can you help?

One way that members in the medical profession can assist in achieving the ONC’s 10-year vision plan is to provide feedback throughout the process. You can start by reading the vision plan and roadmap to get an idea of the big picture. Make a note of any specific obstacles or additional considerations that stand out in your mind as you review the plan. Consider the timing, responsible parties and actions proposed to ensure they are appropriate, given the current timeline, and note any gaps in the plan. The ONC is accepting public comments and key commitments on the draft Roadmap from now until April 3, 2015 at Now is the chance for all IT stakeholders to provide feedback on the plan and guiding principles and help to shape the future health IT infrastructure for the entire nation. The ONC even challenges you to commit or take the lead on a critical action. The ONC will continue to update the Roadmap, and plans to release a new version later in the year, along with a draft of the 2015 Interoperability Standards Advisory that will specify priority specifications for implementation. If you would like further information on how to get involved with the 10-year vision plan, the ONC also offers review training courses and additional reference documents online, which you can find at the link above.

The ONC is confident that their 10-year vision plan for interoperability is “consistent, incremental yet comprehensive.” They recognize that they can only achieve this vision with the help and support of many organizations, government agencies, public and private institutions and individuals.