Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

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ONC Issues Draft 2017 Interoperability Standards Advisory

ONC took to heart recommendations for improving its annual update to advise the healthcare industry on its use of health IT standards for advancing interoperability.

- The Office of the National Coordinator for Health Information Technology draft of the 2017 Interoperability Standards Advisory incorporates numerous recommendations made by industry stakeholders.

ONC interoperability advisory

"The input and feedback we have received from across the health IT spectrum on earlier ISA versions has helped us continue to shape the ISA into an effective resource and guide for all who are engaged in interoperability work," wrote the federal agency's Steven Posnack, MS, MHS, and Chris Muir on the official ONC blog.

"We have attempted to reflect the ongoing dialogue, debate, and consensus among industry stakeholders," they continued, "particularly where more than one standard or implementation specification could be used to fulfill specific clinical health information needs."

The two directors from the Office of Standards & Technology also noted an important first for this year's Interoperability Standards Advisory:

The draft 2017 ISA also represents the first phase of ONC’s effort to transition the ISA to an interactive online platform, starting with the publication of this draft as an online version. Additional interactive functionality will be built throughout this year.  Our goal is to shift the ISA experience from a static, PDF to an interactive, wiki style product that stakeholders can more fully engage with and shape.  This will enable more efficient, closer to real-time updates and comments as well as other valuable features, such as hyperlinks to projects in the Interoperability Proving Ground that are using a particular ISA-referenced standard.  A printer-friendly version of the ISA will be made available as well.

Another significant change to the 2017 Interoperability Standards Advisory is the discontinued use of "best available" to describe any one health IT standard (per the ISA itself):

This change, at the recommendation of the Health IT Standards Committee, seeks to address feedback that stakeholders may perceive varied standards and implementation specifications associated with an interoperability need as “best” despite known limitations or low adoption levels. Further, that the ISA serves as a way to “identify” standards and implementation specifications and should be as inclusive as possible in order to increase public awareness about a standard or implementation specification’s applicability to an interoperability need. Thus, a determination as to whether one standard listed in the ISA may be more “fit for purpose” than another (for the same interoperability need) could be reflected by referenced industry experience and the ISA’s associated informative characteristics.

Also included among changes to this year's advisory are the addition of applicable starter sets where appropriate, hyperlinks to active projects that include indication of their use of particular health IT standards, and improvements  to the " pairing of standards for observations (i.e., questions) and standards for observation values (i.e., answers)."

Another noteworthy component of the 2017 ISA is its scope which is limited to the interoperability of clinical health IT systems and not the interoperability of administrative or payment-oriented technology.

The 2017 Interoperability Standards Advisory comprises a total of four sections:

  • Vocabulary/Code Sets/Terminology
  • Content/Structure
  • Standards and Implementation Specifications for Services
  • Questions and Requests for Stakeholder Feedback

The changes to the ISA's scope as well as structure follow recommendations submitted by the 2017 Interoperability Standards Advisory Task Force to the Health IT Policy and Standards Committees last month.

As part of those recommendations, the task force advise to the federal advisory committees to ensure that the latest Interoperability Standards Advisory include more than a focus on certified health IT and help eliminate industry gaps:

• ISA TF recommends including standards for interoperability which connect technologies outside the EHR, creating a path where data can be put in once (primary use) but used many times (secondary use).

• ISA TF recommends a section to identify “industry gaps” that exist (per task force/HITSC recommendations) in areas where standards likely would be valuable but are not known to exist. (i.e., data quality in patient matching)

• ISA TF recommends deprecation of listed standards once sufficient experience is gained with newer standards/approaches that offer a clear advantage over previous standards.

The full draft of the 2017 Interoperability Standards Advisory is available on the ONC website.

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