HIE Governance: History Review and Intro to 10-year Interoperability Vision

As the guy ranting at my fellow health IT community members about not making rapid enough progress in bringing interoperability to the point of care, it was tough for me to feel enthusiastic going into today’s ONC webinar entitled “Advancing Interoperability Through Standards – Health Information Exchange Governance.”

On balance, however, I was pleasantly surprised.

Governance History Lesson

The primary webinar speaker was ONC’s Policy Office director Jodi Daniel, a truly dedicated public servant who has been at ONC since its formative days. Jodi gave a nice review of the conceptual origins of governance (using the U.S. Constitution as the ultimate example), then talked through the three major time periods of ONC’s role in curating the definition and launch of HIE governance.


Before HITECH started way back in November of 2004, when ONC published their first RFI seeking input on how to best establish nationwide interoperability.

These efforts involved the federally-chartered AHIC (public sector) and the National eHealth Collaborative (private sector), now part of HIMSS. This period produced the Federal Advisory Committees, of which the Health IT Standards and Health IT Policy committees continue to thrive.

The 2009 HITECH Act (part of ARRA) formalized ONC’s mandate, re: HIE governance, with language directing ONC to “establish a governance mechanism for the nationwide health information network.” To make that a bit more tangible, the ONC team translated the HITECH Act directive into:

The establishment and oversight of a common set of behaviors, policies, and standards that enable trusted electronic health information exchange among a set of participants.

With a governance focus on:

Health information exchange at a national level, to address challenges to exchange between different exchange organizations and across state boundaries.

This period included a tsunami of ONC activities to guide the HIE governance process forward, and I won’t repeat everything here. You can see all the details for yourself by looking at the full slide deck from the webinar. A nice summary of these efforts is the following “framework” graphic.

ONC Governance Framework
ONC’s HIE Governance Framework

The most notable outcomes of this period were that ONC gathered enough input from industry and federal agencies as they fleshed out this governance framework to encourage public-private partnerships to run with HIE governance

This process culminated in the decision by ONC to end their HIE governance rule making in late 2012. This decision had the tangible (and positive) result of Healtheway being formed to carry forward the governance process for the Nationwide Health Information Network (NwHIN), now called the eHealth Exchange.

AEGIS is proud to be working closely with the Healtheway team facilitate the participant onboarding process with our Developers Integration Lab (the DIL).

Moving Forward: ONC’s 10-year Interoperability Vision

Armed with that historical background, the main takeaway for the webinar audience was to go read ONC’s 10-year Interoperability Vision white paper and participate in the public comment  process which will end soon.

There was a fair amount of material here, but my favorites were:

  • Build incrementally over time from current technology– multiple methods of exchange required
  • Focus on establishing best minimum possible for all; this creates room for innovation
  • Maintain focus on and empower individuals

These are essentially the crux of my rant from the other day.

Given that ONC’s focus is the governance of health information exchange at the national level, I find this deliciously ironic (because my rant was about not doing this enough for point-of-care interoperability).

During this part of the webinar, Jodi and team highlighted the graphic I love and hate:

ONC Roadmap 3-5-10


I hate this because it suggests that we all have to wait until 2017 before we have basic interoperability.

I love this because it doesn’t suggest that we wait longer than that.

This obviously wasn’t the point of including this graphic in this webinar–as evidenced by the arrows highlighting that the governance framework ONC worked so hard to curate lays the foundation for all of these goals to be achievable.

Help Forge the HIE Guardrails

It’s obvious from current messaging by ONC officials that interoperability is a major focus right now, and I applaud this. I really hope the current momentum persists long enough to realize the vision.

The initial comment period about the white paper just ended, but there will be another comment period on “version 1.0” of the resulting “interoperability roadmap” in early 2015–following feedback from ONC’s Federal Advisory Committees (FACAs). You can get plugged into that public input process by going here.

A key takeaway on this whole roadmap process was that the public is also welcome (and encouraged) to attend these FACA sessions. For this initiative, the Policy: Governance Subgroup  is the focus, which (in another example of delicious irony) was having their meeting during this webinar. (Whoops!)

Then again, I was interrupted by a phone call at about this point in the webinar, so I may have mixed this up. I say this also because I did catch Jodi saying that the October meeting would focus on this topic, and the ONC FACA calendar shows this on 10/9,  but this workgroup is called “Policy: Interoperability & HIE.”

I will update this post when I clarify this; in the meantime, here’s the link to the October 9th meeting.

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