- The 2017 Interoperability Standards Advisory Task Force (ISATF) has submitted a host of recommendations to assist ONC in drafting its next interoperability guidance for the healthcare industry with an emphasis on ensuring health IT interoperability across the care continuum and making the process of issuing guidance user-friendly.
The task force submitted its comments to the Health IT Policy and Standards Committees earlier this week, which served as talking point for a joint meeting of the federal advisory committees this month. In those comments, ISATF noted that the Interoperability Standards Advisory (ISA) is an integral component of ONC's Nationwide Interoperability Roadmap.
And the process for drafting those guidelines is important. "The Interoperability Standards Advisory process represents the model by which ONC will coordinate the identification, assessment, and determination of the 'best available' interoperability standards and implementation specifications for industry use to fulfill specific clinical health IT interoperability needs," the task force explained in its comments on July 27.
The ISATF recommendations span eight pages and include topics ranging from best available health IT standards and uses to strategies for approaching research, patient matching, and application programming interfaces (APIs).
But first and foremost, they take to task the scope and structure of the ISA.
Pertaining to the focus of the ISA, the task force recommends the guidance to include more than a focus on certified health IT:
• 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 last item is noteworthy in light of the emergence and maturation of Fast Healthcare Interoperability Resources (FHIR) and reported limitations associated with extant health IT standards (e.g., CCD, CDA, C-CDA). Likewise is the first considering variations in EHR and health IT adoption among non-primary care providers and the latter's capacity for health data exchange.
The structure of ISA is where the task force is seeking a "more dynamic experience for users."
Its recommendations include ONC sharing information about health IT interoperability use cases, public comments and ONC responses, and links to authoritative resources on health IT standards and interoperability via its website. The task force also recommends the ISA to differentiate between core and projected health IT standards more clearly.
Additionally, the group is urging ONC and its advisory committees to do away with "best available" when discussing health IT standards and in its place is recommending the use of "recognized standards."
As part of one of its lengthier recommendations, the task force is calling on ONC to make clear in the ISA "key differences between API-based interoperability standards and previous approaches." One of those key differences, the task force claims, should be in maintaining "clear distinction between the lower-level standards that make up the 'building blocks' (e.g., FHIR, OAuth 2) and the higher-level use-cases that leverage the lower-level building blocks."
Of the latter, the task force is seeking the production of implementation guides highlighting the role of "core API standards" as part of these higher-level use cases and including additional specifications and constraints.
Along with its recommendations for the ISA, the task force is also requesting additional time to focus on other areas of the annual interoperability guidance in a second phase.