Q: What is the mandate of the the JASON task force?

A: The JASON Report was inspired by a couple things. Well, there are two pieces to it: what was the original question that was asked of them, and what was their motivation as they started to look at it. The JASON process is sort of highly-structured. And somewhat, I don't want to say secretive, but designed to bring together experts where the individuals aren't identified. It's not like I, or David McCallie, who's co-chair of the JASON task force, have conversations with individuals who contributed to the report. We literally don't know who those individuals are.

But the original question that was asked of them by the federal government was really to look at the ability for health information exchange to contribute to a platform or platforms to be able to do better research, to improve healthcare. It was very focused, the original question was focused on that: If it can help with clinical care, great, but it was really focused on this question of how can it help to enable research.

But then, I think, if you read the report, you see one of the things they look at and are struck by, which I think most people would agree with, is that, jeez, interoperability really isn't very far along. It's really not where any of us really hoped it would be. I think that that's an observation that resonates with people: Its unsatisfactory, in many ways, where we are right now.

So they came up with a proposed architecture and proposed approach for thinking about how one might enable a way for a nationwide approach, to have an ability to aggregate and normalize information, such that it can be used for clinical care, used for research, and used in a better way by patients to manage their own care.

So that's roughly what the JASON report was about and the solution they proposed. We've got the task force now that is looking at it, and we're still in the middle of our deliberation, but I think one of the things we've talked about on the public workgroup calls is a sense that, in terms of the overall perspective of the JASON authors that, 'Yeah, we're not as far along as we'd like to be. There's is a sense, though that there's probably more progress in various types of health information exchange than the JASON authors seem to give credit for.

Some of that may have to do with timing. They were asked to start on this almost two years ago. There's a long lag in the process – they put together the committee and embark on their investigation and they issue their report and the government approves the report, then decide to release it. They started thinking about this two years ago, and only now are we seeing the report. So it may be that they didn't have the opportunity, because a lot has happened over the past two years, to be able to accurately reflect the current status.

So I think there's more progress than they give credit for.

Q: Where are some of these pockets of success?

A: If you look a the Massachusetts statewide HIE, which had hundreds of thousands of transactions a month, among providers sending to quality data warehouses like ours and others, that's growing every month. And providers pay for those services. If you go into Rochester or Albany, or Indianapolis, or Cincinnati, there are, alive and well, health information exchange organizations where people are actually doing the things the JASON authors would like us to do as a country. They didn't seem to give credit to places where that was actually going on.

We want something across the country, and to be available nationwide. Which they properly point out has not happened. And, I think, they properly point out that there is no top-down roadmap. And they're trying to suggest a bit of how to do that.

So as we dive into it more, we're now in the middle of taking a lot of comments, we've had a lot of listening sessions and a wide variety of perspectives on the current state of interoperability. I think one of the challenges as we think about the JASON approach is how do we take what they seem to be recommending – as I said, the authors are anonymous and there's no opportunity to go and ask them questions, and the report is relatively short, although very well-written and concise – but in something as complex as this, we don't have the opportunity to go back and ask, "What did you mean by this, it's not clear.' You just have to interpret what you get from that.

But I think there is something of a question: it seems to suggest a single architecture for the entire country, and I don't think that's something that was in the minds of the JASON authors. As we look at a country as complex and heterogeneous as ours, it's clear that there is no single solution that will work in Arizona and in Massachusetts. Those are going to be perhaps different types of architectures, perhaps different types of exchange activities that happen within those markets. And I shouldn't even draw it on state boundaries, because healthcare spills across borders, but in different parts of the country you're going to see different things happening.

So that's one challenge, to figure out how to interpret what seems to be a single architecture in a very complex economy that probably can't have a single architecture like that.

The other thing that they noted is they listed a whole bunch of challenges to having better interoperability, and they noted legal obstacles, business obstacles, policy obstacles, cultural obstacles. They pointed out a number of those, and then they explicitly said, "We recognize those are obstacles, but we're not going to talk about them in our report, because we're focused on the technical side."

But a lot of the challenges we've seen in interoperability haven't been about the technology. They've been about all these other things. To the point that the JASON report focused on the technology piece of things, that's great, and there's probably some valuable pieces to that, but if you consciously don't address things that a number of us would probably say are very important pieces, you're only getting more of the story.

Q: So your role is to digest all this and then recommend to ONC what sort of strategy they should take in implementing their suggestions.

A: The JASON report had some specific recommendations for ONC. There's a long list of them. We'll sort of take the structure of having some comments on their observations, just to make sure we have a sense of, here is their empirical view of the world, and do we agree with that? We want to make sure we say, if there's any disagreement we have as a task force, with some of their empirical observations, let's make those clear. And as I said, we think there are some places where they didn't give enough credit to what is going on. Those are the kinds of things we may want to point out.

And then in the recommendations, we'll go down and have comments on a number of the recommendations. Some we'll agree with, some we'll disagree with, some we'll remain silent on. And then there are some recommendations that are specific to ONC: that within 12 months ONC should come up with a blueprint for the JASON architecture. Those are the types of things we might provide a little advice on the feasibility of that.

After we brief the policy and the standards committees (this week and next) there will be a joint meeting of the policy and the standards committees and we'll be making our final recommendations at that meeting.