For the third year in a row, the Office of the National Coordinator for Health IT has issued its Interoperability Standards Advisory, providing the healthcare industry with a listing of standards and implementation specifications meant to enhance the flow of electronic health information.

The 2017 Interoperability Standards Advisory (ISA) serves as a coordinated catalog of standards and implementation specifications to be used by different stakeholders as a single public list focused on clinical health IT interoperability.

Steve Posnack, director of ONC’s Office of Standards and Technology, says this year’s advisory is more comprehensive; it now includes revisions and additional descriptive text for several of the six informative characteristics designed to provide insight into the level of maturity and adoptability of the standards and implementation specifications.

Steve Posnack

In addition, the 2017 ISA moves from being a static PDF document to an interactive online platform, enabling stakeholders to more fully engage with and shape the advisory on an ongoing basis, enabling more efficient, close to real-time updates.

“The web-based version of the ISA is expected to be updated frequently throughout the year as needed to reflect real-time updates to standards and implementation specifications from standards development organizations (SDOs) and allow dialogue and debate between stakeholders about the ISA’s interoperability needs, standards, and implementation specifications on an ongoing basis,” states the advisory.

According to Chris Muir, division director of HIT infrastructure and innovation at ONC, this year’s ISA has discontinued use of the term “best available” in response to public comments and a recommendation from the Health IT Standards Committee.

“Some of the standards had low adoption rates, so it was hard to identify them as being ‘best available,’ ” says Muir. “If two standards did the same thing, the ‘best available’ label for both of them really didn’t provide any additional value.”

To differentiate them from mature standards and implementation specifications, the ISA highlights “emerging” standards and implementation specifications by shading them in a lighter color and italicized for additional emphasis.

However, in an October letter to National Coordinator for Health IT Vindell Washington, MD, the American Hospital Association expressed its concerns that the draft 2017 ISA needed more detail to describe how ONC distinguishes mature from emerging standards.

Also See: ONC interoperability standards advisory needs more detail

“The consistent use of mature standards is essential to solving the interoperability challenges facing our nation,” wrote Ashley Thompson, AHA’s senior vice president for public policy analysis and development. “The Draft 2017 ISA uses the term ‘adoption level’ to indicate whether a standard has been adopted in healthcare and a graphic to indicate the level of adoption, from low to high, for a particular standard. However, experience to date indicates that a standard may have a high adoption rate as a result of a health information technology certification requirement, although it does not meet provider needs.”

Consequently, AHA recommended that the 2017 ISA assess the successful use of the included standards, not just adoption, in order to properly evaluate the ability of a standard to support interoperability. The association also advised that document include information on actual standards use in the real world, and not just adoption.

“We’re also looking for ways to not only measure the adoption of standards and products but their use out in the field, and we do recognize that there’s a difference,” says Muir. “We don’t have a good way of doing that right now.”

According to the 2017 ISA, adoption means that the standard or implementation specification is being used in health IT in the field by end users to address a specific interoperability need. Adoption levels listed in the ISA are based on ONC’s analysis of several factors, including:

  • Whether and/or how long a standard or implementation specification has been included in regulation for health IT certification (if applicable) or another HHS regulatory or program requirement which is used only as a proxy for industry adoption;
  • Feedback from subject matter experts and
  • Public comments

Posnack acknowledges that “a standard in and of itself is not going to be sufficient to support everyone’s needs and purposes” and in response to the AHA’s comments concludes “that’s the type of constructive feedback that helps make the ISA better.”

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