The Office of the National Coordinator has shared the reams of public feedback it's received in response to the first draft of its Shared Nationwide Interoperability Roadmap. Opinion ranges from enthusiastic support to flat opposition, as stakeholders and members of the public weigh in with their perspectives on technical specifications, provider impact, privacy concerns and more.

A month or so after the roadmap was first released in January, ONC shared statements of support for the initiative from industry and goverment groups such as HIMSS, CHIME, the Department of Defense, American Academy of Family Physicians and more.

[See also: Key takeaways from ONC's interoperability roadmap]

The public comment period closed April 3, and on Friday ONC published the voluminous input it's gotten from providers, vendors, HIEs, state health organizations, advocacy groups, members of the public and more.

Here's a tiny, random sampling of what some of those folks had to say about the interoperability roadmap:

[See also: HIE Roadmap comments generally positive: ONC]

"The National Rural HIT Coalition supports the ONC Interoperability Roadmap. Rural healthcare providers have unique challenges that are directly impacted by improved EHR interoperability. These challenges include limited HIT workforce, geographically broad referral networks and a shortage of primary care and other providers. Rural communities will likely benefit more than urban from supporting and developing models for interoperability across the care continuum."

"The Alliance supports the direction of, and sentiment behind, the roadmap, and commends the Office of the National Coordinator for Health IT's efforts in focusing attention on the need for national interoperability in health information technology. With the roadmap, ONC is demonstrating an interest in moving forward the discussion of interoperability as a central component of a more efficient and cost-effective healthcare delivery system. As noted previously, the idea of a shared Nationwide Interoperability Roadmap is critical to providing high quality care to patients regardless of where they are treated in the continuum. Additionally, the Alliance appreciates the mention of home healthcare and long-term and post-acute care in the specific discussion of future care delivery and the move to community-based models of care delivery. The Alliance supports the work being done in the context of the S&I Framework's electronic Long-Term Services and Support initiative, and looks forward to engaging with the initiative."

"The actions proposed in the roadmap are the right actions to improve interoperability in the near term. Overall, the short-term actions seem appropriate to energize and increase public/private national participation in health IT interoperability. In keeping with the general industry trend of improving quality of care, engaging patients and reducing cost using health IT as a vehicle, the strategies were appropriate. Overall, the target of the short-term actions point towards enforcing behavioral changes and removing current barriers to interoperability through public-private collaborative governance, better alignment of stakeholders' policies, standards and practices."

"The Roadmap approach to Governance, Architecture and Infrastructure and security & privacy are very good and shall require work, collaboration and testing and validation before deployment to be useful. SEMHIE agrees that solutions should be vendor neutral and the architecture should allow for the process of multiple solutions as healthcare is a rather diverse and fragmented industry."

"This bill will interfere with our ability to take care of patients by putting government and insurance companies first and permitting them to stop tests after they are ordered by providers due to real time access to charts which could cause serious harm to patients. It also would create a good opportunity for cyberattacks and give way too many people access to data and information about patients violating a right to privacy. It will be extremely costly and drive up costs for everyone. Please do not implement this system!"

"We urge the government to scale back its proposals and not expand into this field. The free market can work amazingly well when allowed to do so. The market for smart phones is a shining example of how much free enterprise and technology can achieve for the public with little or no regulation by government. Likewise, systems for managing medical data are more likely to develop faster and with more efficient results in the absence of government involvement. The free market can better achieve the goals for patients and the medical community. In addition, states have proper jurisdiction over medical care and it would be an intrusion on state sovereignty for the federal government to expand into this area."

"The Open Source Electronic Health Record Alliance would like to point out the advantages that can accrue from the adoption and extension of open source solutions to address the issues in the Roadmap. In particular, deployments of open source versions of the VistA EHR not only enable data aggregation but also provide frameworks for interoperability at low cost. Such capabilities can be seen in OSEHRA's ViViAN visualization tool at code. OSEHRA.org/ViViAN, which illustrates how open source VistA allows interoperability via HL7, remote procedure calls, and web services. Current VistA prototypes and development efforts, underwritten by interested public-sector and private-sector organizations such as ONC and supported by an aware and enthusiastic community, can make HL7 FHIR and similar RESTful standards available in a short time at low cost. These standards, in turn, can enable "quick wins" in areas including real-time results visualizations such as those being developed by the Health Services Platform Consortium and being prototyped in current projects at the Veterans Health Administration."

The full list of responses is 17 pages long. Read all the comments here.