Recapping the ONC Interoperability Forum

Last week I attended the 2nd ONC Interoperability Forum. The event was billed as an opportunity to, “bring people together from ONC, our federal partners, the healthcare industry, and the technology sector to:

• Learn about recent efforts to advance interoperability nationwide

• Identify concrete actions in response to current interoperability barriers”

This was my first time at an ONC sponsored event and I found the experience interesting on many levels. I’ve outlined my observations from the event below in an effort to share the experience with you all.

Day 1

The first day of the conference was highlighted by Seema Verma, Administrator, Centers for Medicare and Medicaid Services (CMS). Her soaring call to end the fax machine in healthcare by 2020 was repeated throughout the week. Similar calls have been repeated since the beginning of the Meaningful Use program, so time will tell if this most recent push is discernibly more effective.

The best demo of the day was of Blue Button 2.0 - a patient-facing way to access CMS data. I immediately signed up for a developer account after seeing the demo and have to admit that the project is pretty slick. I’m very curious to see what adoption looks like. A clever solution doesn’t matter much if it isn’t used. The real measure of the technology will not be the number of apps signed up or developer accounts created, but the actual number of CMS beneficiaries who authorize apps to use their data. I’ve gone on record as being skeptical that these Facebook-like health data apps are a good idea, and I’m also skeptical that CMS beneficiaries will be super engaged with the site. That being said, I’m entirely prepared to eat my words.

I learned the most from the 21st Century Cures 101presentation by Elise Sweeney Anthony, Executive Director, Office of Policy, ONC. The talk was a rough highlight of some of the important language that is being hammered out in the 21st Century Cures act. She laid out the difficult areas of the law and what Congress was asking them to do. It was eye-opening for me personally and underscored the importance of public comments on legislation.

Day 2

Since Redox is what we like to call the “missing link” in healthcare infrastructure, I decided to spend day two on the “Interoperability Infrastructure” track.

I was able to share my perspective during a what’s working/what’s not working session. I put a star on the progress that’s been made in opening standards and making the documentation better. In 2012 you had to pay for HL7 standards, huge PDF documents that had a restrictive license, today FHIR is a robust website, generated through CI server, licensed under creative commons. This is a huge improvement.

On the negative side, I lamented that it’s often hard for people to participate in standards development or even testing due to cost (both time and money). The cheapest organization price for annual membership will be $1500 in 2019, compared to $22k for companies making over 100 million in annual revenue. That’s totally out of sync with what the big boys make (billions in revenue) and is regressive at best. Similarly, attending events like the FHIR connectathon and the IHE connectathon are even more expensive - almost $9k just to test your software.

The breakouts were effective and I met a lot of great people. We focused on the cost of infrastructure. Specifically, we dug down into what is not be accounted for in the cost of some newer infrastructure, say Commonwell for example. We ultimately arrived at the speed at which networks reach a critical mass, and presented solutions for speeding up adoption and putting that cost into the model. The notes are here and credit goes to Josh Mandel and Jitin Asnaani for leading a great track.

Day 3 and conclusions

Day three was a series of recaps of day two and demos of technology such as Apple’s FHIR interface. The demos struck me more as marketing presentations, and the panel recaps ranged from good to totally bewildering (I probably would have died in the blockchain session).

Overall, the state of healthcare interoperability to me seems much as it was 5-10 years ago. The optimists see us on the cusp of something great, the pessimists hide, and the realists say “look at all this stuff we’re already doing”. I put myself in the realist camp, which is coincidentally where we started Redox at - we have all this data flowing, let’s just make it easier to tap into.

My biggest takeaway is that Meaningful Use, now called “Promoting Interoperability”, might be a necessary if imperfect tool that the government continues to use to push the industry forward. The 21st Century Cures act and TEFCA will certainly be important pieces of legislation to watch and I look forward to reading them, both to help Redox customers, and help move our industry in the right direction.

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