Roadmap toward learning health system finalized

The final version of the roadmap for achieving nationwide interoperability of health information technology (IT) systems focuses on the first priority goal of improving health care quality and outcomes by using priority data domains. The Office of the National Coordinator for Health IT (ONC) hopes to quickly achieve some short-term success to provide momentum for the long-term vision of enabling a learning health system that can easily exchange electronic health information and facilitate the creation of knowledge. The roadmap is split into three sections: drivers, policy and technical components, and outcomes. Like the draft version, there are agendas for three different phases spanning the next 10 years (see Long awaited roadmap for health IT odyssey unveiled by the ONC, Health Law Daily, January 30, 2015). The ONC will create new versions of the roadmap as needed to reflect new achievements and challenges.

Alternative payment models

The driver of a supportive payment and regulatory environment will serve as a push to create a world in which interoperability both improves care and is a sound business decision. The ONC points out that shifting payment models to rewarding quality of care versus quantity of patients seen is vital to proving to industry stakeholders and that interoperability makes sense from a business perspective. It believes that the current environment does not encourage the exchange of health information. To achieve this supportive environment, CMS will start by attempting to pay 30 percent of all Medicare claims to providers through quality-based alternative payment models by the end of 2016 and increase that amount to half of all claims by 2018. The ONC hopes that by 2021-2024, value based models will the dominant form of payment.

Functionality and security

The roadmap includes many policy and technical components for establishing and maintaining interoperability. The ONC hopes that shared decision-making will allow the industry to create new ways of sharing electronic health information to fill in the gaps and smooth out the conflicts created by the current approaches. It is also concerned about the increased number of cyberattacks on health information and is focused on maintaining a secure network. It will work toward widespread adoption of cybersecurity frameworks and focus on ensuring that all individuals and machines that use the learning health system are authenticated. It will also work to develop an industry-wide testing infrastructure to ensure that systems operate properly as various components evolve and change.


The ONC believes that when the learning health system is established, patients will have fast and easy access to their health information and will be able to direct it where they wish. Although policy changes have resulted in increased access to electronic information, the ONC still wishes to see a truly “person-centric” system. Another outcome of the learning health system will be the ease with which providers can coordinate care, allowing for better treatment decisions and a team-based approach.