WEDI Submits Comments on ONC Interoperability Roadmap

12 action steps identified for ONC, based on industry interoperability survey findings

RESTON, Va. — April 07, 2015 — The Workgroup for Electronic Data Interchange (WEDI), the nation’s leading nonprofit authority on the use of health IT to create efficiencies in healthcare information exchange, released the survey results of its March 2015 interoperability survey along with an April 3 letter of recommended action steps to the Office of the National Coordinator of Health IT.

As a response to the call for comments to the interoperability roadmap released by the Office of the National Coordinator of Health IT, WEDI issued an industry survey in March 2015 to gauge current electronic information exchange efforts, pinpoint challenges to interoperable exchange, and measure support for a national patient identifier among healthcare stakeholders. Based on the survey responses from 372 organizations, including health plans, providers, health IT vendors, health information exchange organizations and other participants, WEDI relayed the following key observations from the survey findings:

Universal Patient Identifier (UPI)

  1. Current patient matching methodologies are insufficient and ineffective. Healthcare providers report that only 25 percent of electronic patient records are successfully matched on the first pass without manual intervention.
  2. Stakeholders appear to be generally favorable towards a universal patient identifier. A UPI would be supported by 68 percent of organizations surveyed, including providers (62 percent), health plans (79 percent), and health IT vendors (70 percent).
  3. Health data is encrypted when in‐transit to external organizations – however, organizations continue to lag in encrypting data internally and at‐rest. Healthcare providers report that some electronic health data, i.e. 51‐100 percent, is encrypted when in‐transit externally (49 percent), in‐transit internally (35 percent), and at‐rest (36 percent).

Exchange Capabilities

  1. Direct is the primary method currently used by organizations to electronically exchange health information. Direct is used routinely or occasionally by providers for internal exchange (81 percent) and external exchange (63 percent).
  2. Healthcare providers are unable to easily exchange clinical information electronically with non‐affiliated healthcare organizations. With the exception of sending to pharmacies, less than 25 percent of provider organizations are able to easily send information to most non‐affiliated healthcare organizations.
  3. Health plans are also unable to easily exchange clinical information electronically with other organizations. Less than 33 percent of health plans are able to easily send information to most non‐affiliated healthcare organizations and less than half are able to easily receive clinical information electronically from other organizations.

Barriers and Challenges

  1. Organizations have difficulty with leveraging electronic data – particularly the process of blending structured and unstructured data. Provider and health plans report difficulties with blending structured and unstructured data (56 percent) and integrating different types of data (44 percent).
  2. The majority of organizations find financial barriers to be a challenge to electronic data exchange, from developing capabilities to ongoing maintenance and fees. Provider organizations are challenged by financial barriers such as infrastructure costs (67 percent), connection and set‐up fees (64 percent), ongoing transactional fees for exchanging data (63 percent), training staff (61 percent), and ongoing membership fees for participating in an HIE (59 percent).


  1. To date, the electronic exchange of health information is slow to yield strong improvements among healthcare stakeholders. Less than half of provider organizations report that electronic information exchange has improved performance measures such as care coordination (48 percent), information flow (42 percent), quality of care (40 percent), and safety (40 percent).
  2. Organizations are optimistic that electronic exchange of health information will contribute to improvements in the next year. Providers expect exchange to improve care coordination (69 percent), quality of care (66 percent), and information flow (66 percent), and worsen cost of care (7 percent) and provider satisfaction (7 percent).

Health IT Market

  1. Vendor systems provide mixed levels of exchange functionality with other health IT products. Vendors report that their systems (self‐built or in partnership with other vendors) currently facilitate external data exchange of data types such as demographics (84 percent), insurance enrollment/eligibility status and benefits (77 percent), hospital ADT (68 percent), and summary of care records (65 percent).
  2. Vendor systems are still nascent in their patient‐centered capabilities. Little functionality is available to facilitate exchange of patient‐centered information such as patient‐reported data (38 percent) and advanced directive (43 percent).
  3. Vendor systems can generally offer strong data exchange capabilities. Systems are equipped to exchange structured clinical data (81 percent) and administrative data (88 percent), as well as unstructured clinical data (74 percent) and administrative data (81 percent).
  4. A minority of vendors have developed revenue models from providers sending and receiving electronic health information, including transactional, monthly, and annual fee structures. Among the EHR vendors surveyed, the most common form of revenue is a monthly fee (33 percent); no EHR vendors reported other fee structures.
  5. More alignment among vendors is needed to advance interoperability. Vendors report a number of barriers to the electronic exchange of health information, including the lack of interoperability with other vendor systems (67 percent), unstable market (62 percent), cost of development (63 percent), and lack of consensus around required data standards (59 percent).

The full reporting of survey results is available on the WEDI website along with the complete letter to ONC. Based on the survey results, industry stakeholders appear to continue to move forward in their efforts to exchange clinical information, but growth is inhibited due to implementation costs and limited visible impact on clinical and business outcomes.

“WEDI applauds the work of ONC to develop a common framework for interoperability in our nation through the release of the recent roadmap,” said Devin Jopp, Ed.D., WEDI president and CEO. “However, what we’ve found — from not only this industry interoperability survey, but also from our discussions around concerns from key groups — is that there are significant barriers to interoperable electronic data exchange that remain to be addressed across providers, health plans and vendors alike. We want to ensure that the roadmap is one that is realistic and viable for all entities involved, so that the industry can rally together around the work, rather than be discouraged or hesitant.”

About WEDI

The Workgroup for Electronic Data Interchange (WEDI) is the leading authority on the use of health IT to improve healthcare information exchange in order to enhance the quality of care, improve efficiency, and reduce costs of our nation’s healthcare system. WEDI was formed in 1991 by the Secretary of Health and Human Services (HHS) and was designated in the 1996 HIPAA legislation as an advisor to HHS. WEDI’s membership includes a broad coalition of organizations, including: hospitals, providers, health plans, vendors, government agencies, consumers, not-for-profit organizations, and standards development organizations. To learn more, visit and connect with us on Twitter, Facebook and LinkedIn.