Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

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HIMSS: Health IT Standards Guidance Lacking in Many Areas

The group with found several faults in ONC's guidance for health IT standards to promote healthcare interoperability.

- Leaders of the Healthcare Information and Management Systems Society (HIMSS) recently put pen to paper to recommend a multitude of changes to the Draft 2017 Interoperability Standards Advisory (ISA).

HIMSS on health IT standards

In a letter to the Office of the National Coordinator for Health Information Technology (ONC), HIMSS leadership praises the federal agency’s decision to focus on clinical health data before highlighting a number of areas where the guidance on health IT standards can be improved.

First, the next iteration of the 2017 Interoperability Standards Advisory must take into account the needs of researchers who rely on interoperable health IT standards for secondary uses of clinical data. To that end, HIMSS calls for ONC to expand the scope of the ISA.  

Second, the group is critical of the federal agency’s decision to do away with the use of “best available” when describing health IT standards and specifications, a decision HIMSS leaders contend “will minimize the importance of the ISA as guidance to the industry, and does little to encourage implementers to adopt and align on the standards identified.”

The organization recommended that ONC weigh the value of using “stronger language” to promote the use of established health IT standards and highlight the development of those emerging.

Third, HIMSS emphasizes the need for including data provenance as a provision of the ISA and requests ONC to perform studies in the field on capturing this data in current health IT systems and to meet with stakeholders to discuss approaches to validating data sources.

“We think that existing and emerging standards should focus on enabling capture and exchange of provenance information at the data element level to ensure traceability of data to a sufficiently granular level,” the letter states.

The letter points to recent development in healthcare IT as justification for confronting the issue of data provenance:

Data provenance is an important topic that is continuing to increase in importance as new trends emerge in health and healthcare. Health Information Exchanges are stimulating increased exchange of health information; the amount of data is exponentially increasing; patient-generated data are playing an increased role in patient care; the number of devices (FDA regulated and non-FDA regulated) that generate new data is increasing on a daily basis; and, health information travels through parallel and/or serially connected information systems (and may be modified by the systems or humans on the way). All of these emerging and growing trends will depend on understanding source information in order to be adopted and effectively used by the healthcare community.

Along similar lines, the letter includes a fourth recommendation that ONC works to identify interoperable health IT standards for supporting provider use of community health and patient-generated health data.

The next two recommendations in the HIMSS letter to ONC touch on specific clinical terminologies and their use in EHR implementations of interoperable standards. The group disagrees with guidance for adoption levels of LOINC standards in instances where it would cause “undue financial or technical burden” or be wholly impossible for older EHR and health IT systems.

Regarding the appearance of the SNOMED CT code system in the ISA’s value sets for interoperability needs, HIMSS leadership recommends ONC make clear to implementer the difference between main and other health IT standards.

Lastly, HIMSS calls on ONC guidance to list health IT standards required by the Health IT Certification Program alongside interoperability needs more prominently.

ONC issued the 2017 Draft Interoperability Standards Advisory in late August. Key features of the latest advisory include the discontinued use of "best available" to describe any health IT standard and limiting its scope to the interoperability of clinical health IT systems and not the interoperability of administrative or payment-oriented technology.

Earlier this week, the American Hospital Association wrote ONC seeking greater specificity in the federal guidance.

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