Task force recommends changes to ONC Interoperability Standards Advisory

A federal advisory committee task force has made recommendations for suggested changes and revisions designed to improve the Office of the National Coordinator for Health Information Technology’s 2017 Interoperability Standards Advisory.

ONC’s ISA provides 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 Task Force presented their recommendations at last week’s joint meeting of the Health IT Policy and Standards Committees.


Currently, the ISA document references Health Level Seven International’s Fast Healthcare Interoperability Resources in multiple places. However, the task force recommended that for areas where the emerging interoperability standard is listed, a notation should be added around the varying level of maturity for different FHIR resources. In addition, a link to the FHIR maturity model should be provided for reference, according to the task force.

“While still in the early stages, FHIR has been identified as a rapidly emerging standard, and is currently garnering the most industry-wide support to be adopted,” said Kim Nolen, co-chair of the task force. “It’s not a regulatory requirement. However, many leading EHR vendors are implementing FHIR to meet regulatory API requirements.”

The task force recommended that a specific definition should be provided to distinguish between the use of FHIR as a “clinical resource” versus as an “API-based approach” to interoperability. “Since FHIR uses the term ‘resource’ and it is used in other contexts throughout the document, we felt it was important to give a clear definition,” added Nolen.

At the same time, she said the task force would like to see a note added to the ISA document that “standards alone are not always sufficient for interoperability, there could be governance and other policy considerations that are required.” According to Nolen, it takes more than one standard to achieve interoperability. “Sometimes it could be governance and policy, other supporting standards, specifications, profiling, et cetera.”

Also See: FHIR expected to supplement, not replace, other standards

Further, she said that where interoperability needs align with ONC Certification Criteria, “we thought that it should be appropriately linked so that people could see where the interoperability cross-junctures with the certification criteria and if it does relate to portions of MACRA/MIPS and Alternative Payment Models, then it should link to the educational resources and have that information provided.”

The task force also recommended that standards listed throughout the ISA are and should remain varied by the use case or interoperability need they support. “You could have a standard that supports different use cases, but then it would be profiled differently. So, you would want to be able to express that in the document,” said Nolen.

“We will be reviewing these new recommendations to determine how we can best incorporate them into ongoing updates to the ISA this year,” says Steve Posnack, director of ONC’s Office of Standards and Technology.

Also See: ONC releases 2017 Interoperability Standards Advisory

“Recommendations from the Health IT Standards Committee through the ISA Task Force have led to several value-add revisions to the ISA,” adds Posnack.

For example, the ISA term “best available” standard has been replaced with “recognized” standard. And, to be listed in the ISA, the task force recommended that recognized standards should be approved by the governing standards development organization (or equivalent governing body) as either a trial standard for pilot use (or equivalent) or approved for production use (or equivalent).

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