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HIMSS Calls for Minor Changes to ONC Interoperability Advisory

HIMSS is looking for more clarification on the ONC Interoperability Standards Advisory, specifically with regard to the quantitative assessments for the various standards.

By Sara Heath

- The Office of the National Coordinator for Health Information Technology (ONC) 2016 Interoperability Standards Advisory is a generally commendable document in need of minor clarifications, according to the Healthcare Information Management Systems Society (HIMSS).


In a letter addressed to ONC’s Karen DeSalvo, MD, MPH, MSc, a group of HIMSS executives praised the Interoperability Standards Advisory, saying that it does a lot to advance the cause of interoperability throughout the healthcare industry. However, there are three key areas within the document that require clarification, the group wrote.

First, HIMSS commended ONC’s inclusions of a value set that would give a quantitative assessment of each of the six standards included in the Advisory. Some of the value sets included in the 2015 Standards Advisory aren’t available for download or are otherwise inaccessible, however.

One possible solution to this could be a central repository in which ONC stores all information regarding the value sets. This repository should be filterable by Health IT Certification Criteria Rule version and implementation specification name.

“HIMSS would also note that a centralized repository would be a valuable tool to ensure consistent development of value sets by all participating authors,” said the letter, signed by HIMSS chair Dana Alexander, RN, MSN, MBA, FAAN, FHIMSS, and HIMSS president and CEO H. Stephen Lieber, CAE. “These repositories are efficient for search and retrieval of value sets, specifically in cases where value sets are similar in their naming convention or the code sets they contain.”

Alexander and Lieber also praised the six best available standards, stating that these standards are helpful for health IT developers in understanding what needs to be included in the creation of a new product.

However, the pair noted that ONC needs to explain how the certification level for these standards will be determined, specifically with regard to the denominator, as that directly affects adoption levels.

Further, the agency must align the implementation specifications with the adoption levels more carefully in order to prevent for underuse of certain implementation specifications.

“Implementation specifications are based on the standards. As you know, if implementation specifications are not utilized then associated standards are not utilized,” Alexander and Lieber explained. “In order to address possible underuse of the standard and accompanying implementation specification, HIMSS recommends publishing a slope of the adoption curve.”

The third point HIMSS raises for clarification is in regards to LOINC questions and SNOMED-CT answers. While the organization praised ONC for separating the two, HIMSS suggests it provide more clarification regarding the origins of the questions.

“HIMSS recommends that when data elements are separated into questions and 3| answers, they should be spelled-out for readers not familiar with the questions,” Alexander and Lieber wrote. “Questions are typically encoded using LOINC, and Values can be encoded using other systems. We encourage ONC to consistently clarify how the data elements are articulated, and the distinction between the question and answer in each of these sections.”

ONC issued its Interoperability Advisory Standards at the end of 2015. The new document was intended to build upon the 2015 Advisory Standards, with some key changes.

"These changes expanded the Standards Advisory’s depth and breadth.  Most notably, the 2016 Advisory includes six informative characteristics for each standard and implementation specification referenced," said ONC’s Director of the Office of Standards and Technology Steven Posnack, MS, MHS, and Director of HIT Infrastructure and Innovation Division Chris Muir in a post on HealthITBuzz.

The six new characteristics included standards process maturity, implementation maturity, adoption level, federal required, cost, and test tool availability. Posnack and Muir explained that these six standards were intended to help the industry gauge the level of maturity the agency expects in health IT interoperability.

"We believe that these characteristics will help provide stakeholders with more context regarding the relative maturity and adoptability of standards and implementation specifications," they continued. "They also help set a baseline that will allow us to track industry progress over time as standards and implementation specifications get updated and retired; move from draft to final; mature from pilot to production; and grow from low to high adoption."



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