A few months ago, I wrote about the frustration of the HealthcareIT community with the lack of interoperability in the industry thwarting the promise of seamless care for patients. As if on cue, the Office of National Coordinator (ONC) came out with a draft interoperability plan on Jan 15th. Yet again, the ONC’s tactic was to emphasize better standards being key to achieving interoperability. However, I was glad to see that they did go beyond that, highlighting the need for governance as a key ingredient in achieving interoperability.
As part of this mandate, ONC chief Dr. Karen DeSalvo’s opening letter calls for continued work on standards, along with motivating these standards through appropriate incentives. Desalvo’s inclusion of motivating through incentives is an admittance that even if we had best-in-class infrastructure and standards to support interoperability, there are still extrinsic forces and motivators holding us from achieving true interoperability. This is an important point to highlight. It explains why the promise of interoperability is yet to be delivered, despite spending billions of tax dollars.
While this is progress, DeSalvo's prescription still falls short in my opinion. I am not convinced of the ONC’s hands-off approach. Simply calling for a public-private partnership and relying on “non-governmental governance” (also known as market-based approaches in the policy circles) would not be enough. The incentives that woke this industry up from its slumber came from Meaningful Use and while it has not given us exactly what we wanted (yet), MU does show that the government has taken an active role. It is essential to realize the natural progression here before trying to reach for bigger goals such as risk management and population health management. Only after incentives and payment models pave the path will utilization and committed adoption of healthcare IT solutions follow.
The 21st Century Cures initiative, a sweeping bipartisan effort to address an accelerating world that requires faster adoption of technological advances, could prove to be a harbinger. It assumes the existence of the flow of data, quality reporting, and value-based payments as a pre-condition. While that is certainly admirable as the “long game”, a firm foundation needs to be laid by the government first.