ONC's 3rd Interoperability Forum: Not Much to Report

Noam H. Arzt, Ph.D.On August 21 and 22, 2019 the Office of the National Coordinator for Health Information Technology (ONC) held its third Interoperability Forum in Washington, DC. More than 600 individuals participated in person with many others viewing the general sessions via webinar. The conference began and ended with half-day plenary sessions while providing five tracks with smaller sessions in between. I attended the Health Information Exchange (HIE)/Community-based Information Exchange (CIE) breakout session on both days.

The plenaries (aside from the usual welcome and farewell messages) focused on the current state and the future state of interoperability. Lots of talk about TEFCA, FHIR, and patient-centered control of health records, but I really did not hear anything new or terribly interesting. There was a fascinating presentation by Dr. Simon Eccles, head off Great Britain's NHSX project, but this is their third attempt at an integrated health information system and it seemed more aspirational than actual.

In the track I attended on Tuesday there was a very good session on public health and health IT, very well attended with varying presentations from CDC, AIRA, APHL, and others. The second set of presentations was on improving coordination between acute and post-acute facilities using FHIR. On Wednesday, the same track had presentations on advancing social determinants of health using FHIR (including the HL7 Gravity Project), and a second set of presentations on health IT and behavioral health. It was nice, frankly, to finally hear some presentations on this topic that were not completely dominated by the opioid crisis.

To be honest, my expectations were fairly low for this conference. FHIR was all the rage. but its limited deployment still has it fairly early in the hype cycle. Until an RCE is named and begins its work, TEFCA is still a distant idea. The majopr market-driven HIE activities (Commonwell, Carequality, SHIEC) did not seem to have a terribly visible presence at this meeting. In fact, the more established HIEs seemed to spend the whole conference wondering out loud why no one was recognizing their role in interoperability. Likely we will have to wait until the publication of the final rule on Information Blocking before we really know what the HIE landscape will look like for the next few years.


The EHR as a community asset

Instead of seemingly endless (well, at least the past fifteen years or so) discussions, conferences, etc. on interoperability, we should recognize the present-day EHR (I prefer to call it the electronic healthcare module, or EHM) as being integral to health care delivery. As such it ought to be considered a shared healthcare community asset, i.e., not dominated by venture capitalists and large healthcare institutions. Interoperability would not be such a problem, and we could (and should) focus our efforts on CDS, A-I, and linking point-of-care with research and public health entities, with highest priority of protection of patient privacy and confidentiality and the security of our HIT systems.