ONC Signals a Shift From Documents to Interfaces

flying cadeuciiAll of you Meaningful Use and Health IT junkies should read Data for Individual Health  Although long, it’s definitely worth a scan by everyone who cares about health tech. This is the third JASON-related report in a year out of ONC and it comes a month or so before the planned release of the first details of ONC’s announced 10yr plan. I think there’s a reason for that much of it introduced by ONC’s earlier post.

There are three key points I would highlight:

First, and most important, this report suggests that HIPAA Covered Entities (mostly hospitals, doctors and their EHRs) are no longer the center. The future, labeled as the Learning Health System, now makes mobile and patient-centered technology equally important as part of the architecture and talks about interoperability with them rather than “health information exchange” among HIPAA CE’s and their Meaningful Use mandates.

Second, this JASON report, unlike the previous two, does not talk about Meaningful Use any more. That money is spent. A lot of orgs are lobbying against any more MU mandates and, although I’m pretty sure there will be a Stage 3, it could be toothless or very much delayed.

Third, Direct, the original Blue Button, Blue Button Plus Push, and CCDA files are pretty much history.  Although the JASONs don’t say it as plainly as I am, document-based interoperability has failed and we’re moving on to Application Programming Interfaces (APIs) that don’t use CCDA or any of the stuff mandated by MU 1 and 2. Blue Button Plus Pull and FHIR, both with a modern industry-standard OAuth security scheme, are the future for all sorts of good reasons which you need to read the JASON reports with some care to understand. It’s all there.

I’m personally not sure Direct will survive the end of the MU incentives and the high cost and address space fragmentation introduced by DirectTrust trust bundles and other failing governance efforts. The future is likely to be founded on web industry standards rather than health vendor standards and be much more respectful of both privacy and cybersecurity as a result. Blue Button may well survive as the portal standard for manual download but the user experience for PHRs will be vastly superior with FHIR and PHRs that survive the transition to APIs are likely to deprecate Direct.

This shift to FHIR will be most challenging for Health Information Exchanges. When every hospital, doctor, and mobile app exposes a secure API using strong, general purpose credentials, what do we need HIEs for?

This shift from documents to APIs will take 12-24 months. It will be interesting to see what ONC does with MU3 to either enhance the shift and keep MU relevant a bit longer or not and simply let it rest in peace.

Either way, ONC should be congratulated for moving as quickly as it did with the JASON process.

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