Q&A: ONC’s Jon White on Meeting the EHR Interoperability Challenge Head On

Ensuring that healthcare providers can use patient information shared between disparate electronic health record systems continues to be one of the biggest hurdles for an industry shifting to reward quality of care over quantity.

It’s a high priority for Acting National Coordinator for Health IT Jon White, who believes that while there’s been progress over the last few years, interoperability of EHRs is not yet where it needs to be.

In an interview with HealthTech Managing Editor Dan Bowman, White discusses the role of the Office of the National Coordinator for Health IT (ONC) in guiding the health IT industry toward improved care, even amid a federal leadership transition. He also talks about the importance of application programming interfaces (APIs) to improve data sharing.

HEALTHTECH: : EHR interoperability has been a bugaboo for the industry. What are your expectations moving forward as you try to resolve the issue?

WHITE: People don’t get all of their care in one place. That means that you’ve got to be able to send and receive information and share it appropriately. There’s been progress on that, as well, but we’re not as far as we need to be.

You’ve got to be able to make that data available to the right people at the right time and in the right way. It’s a little bit more complex than other types of information, but it’s certainly achievable.

In the 21st Century Cures Act, there are very specific provisions about interoperability. A lot of them reflect asks that ONC made to Congress through the legislative process. These are going to help us in terms of new certification criteria that we’re supposed to work on, and our work with the private sector to establish an agreed-upon framework to the information blocking provisions.

There’s a lot of important work ahead of us, but we’ve got some great tools at our disposal.

HEALTHTECH: A common refrain about what will drive interoperability in healthcare is that there must be a business case for providers. Does the push toward value-based care sufficiently shift the industry to ensure that such a business case exists?

WHITE: In value-based care, your reimbursement is tied to the value of care you provide to a population. You can’t provide care to a population of folks without being able to share information with the right people in the right way at the right time. Value-based care absolutely provides a business case for better interoperability.

But really the most fundamental thing at the end of the day is this philosophical agreement that you’re trying to do the best thing for your patients.

HEALTHTECH: What kind of an impact can APIs have on these efforts?

WHITE: APIs are not just a set of technical specifications, but they also are the rules of the way for applications to connect their data. They also importantly include the business rules associated with exchanging information.

Let me take you back to 2013 and the original JASON report called “A Robust Health Data Infrastructure,” which is, to my mind, the first time that we really heard robust introduction of APIs into the conversation around health IT. I was a project officer at the Agency for Healthcare Quality and Research on that report.

The report noted that on one level, the move would open up a lot of room for innovative developers since, on a technical level, use of APIs is how a lot of software works. On another level, the report noted that use of APIs would enable us to get a lot more granular about our data. Pre-API, we certainly had standards for the ways in which data are shared. But APIs allow you a level of specificity about different types of data that you don’t necessarily get through other transport pages.

There was some resistance to the idea initially, but folks came around.

ONC’s certification criteria requires the developers to be transparent about the terms for use of the API, but we don’t dictate what those terms are. I’m waiting for the developer community to step up and make these good, open APIs available on terms that everybody recognizes. We’re waiting for that to come through our certification process.

HEALTHTECH: What prompted initial resistance to APIs?

WHITE: A lot of work had been done on interoperability and some developers said, “Wait, you want us to do something on top of this? What about the work we’ve already put into it?”

Also, API is a machine-to-machine horizontal for exchanging information. I think that that was a different kind of paradigm for folks working on interoperability, so it took some getting used to.

HEALTHTECH: What do you anticipate for ONC amid the transition into a new administration?

WHITE: ONC has a very clear statutory mission, not limited to just the HITECH Act. It also received very clear direction from Congress in the 21st Century Cures Act.

We’ve got some great career folks at ONC and we’re looking forward to working with the new administration. Beyond that, I’m not going to speculate on the future. We’ll see what the administration brings.