Last year, JASON, an independent group of scientists, issued a report criticizing the state of electronic health records (EHR) and health information interoperability and exchange in the United States.
Earlier this month, the Department of Health and Human Services’ (HHS) JASON Task Force issued its report analyzing JASON’s findings and recommendations. The JASON Task Force “agree[d] with the main thrust of the JASON Report,” but also asserted that JASON had overlooked progress that has been made. The JASON Task Force issued several recommendations to improve interoperability and health information exchange moving forward.
JASON is a prestigious, independent panel of scientists established in the 1950s to advise the federal government on science and technology matters. JASON is best known for its defense-related work, but it also produces reports for HHS and other non-defense agencies. The MITRE Corporation provides administrative support for JASON’s work.
In November 2013, JASON issued a report on the current state of health information interoperability and exchange. The JASON Report found, among other things, that a lack of interoperability “is a major impediment to the unencumbered exchange of health information and the development of a robust health data.” JASON also concluded that Stage 1 and Stage 2 Meaningful Use in the EHR Incentive Program “fall short of achieving meaningful use in any practical sense.” The JASON Report recommended that the Centers for Medicare & Medicaid Services (CMS) use Stage 3 Meaningful Use “to break free from the status quo and embark upon the creation of a truly interoperable health data infrastructure.” JASON further recommended that the Office of the National Coordinator for Health Information Technology (ONC), within 12 months, “define an overarching software architecture for the health data infrastructure” to “provide a logical organization of functions that allow interoperability, protect patient privacy, and facilitate access for clinical care and biomedical research.”
In response to these findings and recommendations, HHS formed the “JASON Task Force” to “to analyze and synthesize feedback related to the JASON Report.” Earlier this month, the JASON Task Force issued its analysis. The JASON Task Force “agree[d] with the main thrust of the JASON Report”:
The JASON Task Force (JTF) strongly agrees with JASON’s call for an orchestrated interoperability architecture based on open [application programming interfaces (APIs)] as the foundational approach for nationwide health information exchange. The JTF also agrees with JASON’s observation that current interoperability approaches — based on complex, health-care unique, document-oriented standards and business frameworks — are functionally limited and need to be supplemented and perhaps eventually replaced with API-based models. The JTF thus also agrees with JASON’s recommendation that MU Stage 3 be used as a pivot point to begin the transition to an API-based interoperability paradigm.
However, the JASON Task Force also critiqued parts of the JASON Report. It contended that JASON failed to “accurately characterize the very real progress that has been made in interoperability, especially in the last 2 years,” and did “not accurately portray the broad range of functionality of [current] systems, or the innovation occurring on those platforms.” The JASON Task Force also asserted that the JASON Report’s recommendations and timelines “would be difficult to achieve when taking into account policy, legal, governance, and business barriers.” Finally, the JASON Task Force criticized JASON for recommending a software architecture that “assumes a high degree of centralized orchestration” without “describ[ing] the source, structure, and process for achieving such orchestration.”
Based on its analysis of the JASON Report, the JASON Task Force made six recommendations:
- “ONC and CMS should align the [meaningful use] program to focus on expanding interoperability through the use of Public APIs.”
- “[A] market-based exchange architecture be defined to meet the nation’s current and future interoperability needs based on the following key concepts”: coordinated architecture, public APIs, data sharing network, core data services, and core data profile.
- “The nationwide exchange network should be based on a Coordinated Architecture that ‘loosely couples’ market-based Data Sharing Networks.”
- “The ‘Public API’ should enable data- and document-level access to clinical and financial systems in accordance with Internet-style interoperability design principles and patterns.”
- “Core Data Services and Profiles should define the minimal data and document types supported by all Public APIs.”
- “ONC should assertively monitor the progress of exchange across Data Sharing Networks and implement carefully crafted, non-regulatory steps to catalyze the development of [Data Sharing Networks] and the Coordinated Architecture.”