The Office of National Coordinator for Health IT is about halfway through reviewing comments it received about the Shared Nationwide Interoperability Roadmap proposal it released in late January. And according to Erica Galvez, the ONC’s interoperability portfolio manager, the comments are positive.

Most of the 245 public comments reviewed so far are from healthcare providers and organizations that deliver health IT capabilities, Galvez told a group of HIMSS15 attendees on Sunday morning.

“They are generally supportive of the roadmap, offering suggestions for changes in specific areas,” she said. “They support the notion and tenets of it, with suggestions based more on the details rather than an overhaul.”

Overall, most concerns are about the roadmap being too aggressive in standards adoption and governance processes, which Galvez found “surprising, because I usually hear we’re not working fast enough.” Other concerns are about medical device interoperability, she said.

In sharing information that HIMSS attendees were “the first to hear,” Galvez dissected comments on the Roadmap’s core principles as follows:

• Opinions about the common clinical data set were mixed, with strong support being shown for a standards advisory. There was also support for a unique patient identifier among providers and IT organizations.
• Regarding privacy and security, commenters expressed a fear of liability and pointed out that state laws are more stringent than HIPAA. There is also reservation about the move toward multifactor authentication on individual access and workflow.
• Comments on rules of engagement and government ranged from highly supportive to concern about a “top-down” approach. The organizations serving in a governance role were generally less supportive.

There is wide support for the business, clinical, cultural and regulatory environments and agreement that the shift from fee-for-service to value-based models will help advance interoperability. Providers are wary of facing undue penalties. Looking at interoperability progress and in measuring its success, Galvez said one inhibitor is that most of the standards focus on exchange.

“That makes it hard to measure interoperability and we need better measures,” she said. “We need to understand the capability of technology to exchange in an interoperable manner. We need to understand information flow and usage and focus on interoperability in terms of outcomes and impact.”


The public comment period for the roadmap officially closed April 3, but Galvez said the ONC will have listening sessions at HIMSS in which agency officials will continue to log comments. Meanwhile, public comments for the ONC’s 2015 Interoperability Standards Advisory will continue to be accepted until Friday, May 1.