- Nine recommendations from the US Core Data for Interoperability Task Force (TF) were approved by the Health Information Technology Advisory Committee (HITAC) earlier this week, updating healthcare interoperability elements that vendors must follow.
Both the interoperability standards and their updating process will be worked into the Trusted Exchange Framework and Common Agreement (TEFCA) draft. The finalized TEFCA will explain how health information networks can properly and securely exchange data.
The nine recommendations wanted to address the following common interoperability challenges:
- Data doesn’t exist
- Data exists but is not collected at all or in part
- Data is collected but there are no semantic standards for normalizing it
- Data is collected and there are appropriate semantic standards, but they are not being broadly applied
- Data is collected and semantic standards are applied; however, inconsistent application of semantic and other standards (e.g., use of local or custom codes) by organizations inhibits interoperability
- Detailed and reliable workflows to share the data outside of the originating organization have not been established
The TF explained that having a set of minimum standards in place will encourage a wide variety of data sharing, including data that is unstructured or not mapped to “specific semantic standards.”
Establishing a six stage maturation process through which data classes would be promoted, was the first TF recommendation. Each stage would also have objective characteristics for promotion.
The first stage would identify data objects and classes of value to any stakeholder, TF wrote.
“At the most basic level, it is the end user who assigns value to interoperable data because it contributes to a clinical and/or business need; and it is this value that helps drive adoption,” the TF explained.
“End users (stakeholders) begin the process by proposing data objects and classes they value to a shared public resource that catalogs submissions, and provides a searchable database of data elements, the contact information of the proposer, a value statement, and a proposed/desired level of interoperability,” the recommendation continued. “Using this resource, it is possible to identify all stakeholders who propose similar data objects and thereby identify a community of interest.”
The TF also recommended that the USCDI be expanded as each data class completes Stages 1-4 without a predetermined timeline.
Per this recommendation, an open process should be established for proposing data items or data classes for consideration. There should not be restrictions on what is proposed or who can propose it. Data classes can also only be added to the USCDI after they have met all criteria and have successfully progressed through all prior stages regardless of timeline.
A data class can be advanced to Stage 6 “when the RCE determines adoption is widespread and has exceeded 50% of the long term goal.”
“Consider using the ratio of available data classes in Stage 5 to those having progressed to Stage 6 in the preceding 12 months as a measure to review the processes for prioritization and implementation,” the TF said.
The third recommendation was that an annual publishing cycle for the USCDI be established. The cycle would include periodic bulletins as data objects/data classes progress from one stage to the next.
“Similar to the Interoperability Standards Advisory (ISA) Reference Edition, the USCDI Reference Edition should include the most important and relevant information for each data class in each stage,” the TF suggested. “The Reference Edition should strike a balance between too much and too little information, and could also include summary statistics for the USCDI in general and how it changed over the course of the year.”
Update bulletins should also be released quarterly, highlighting and summarizing “new developments for those who are not participating in the day-to-day work.”
The TF’s fourth recommendation involved incorporating public feedback into each stage. Essentially, a two-month public comment period following the annual publication of the USCDI Reference Edition will give stakeholders time to review the USCDI and provide feedback.
Addressing critical Trusted Exchange Framework requirements to test the USCDI process was also recommended. This will help measure the effectiveness of the RCE in promoting the voice of the individual/patient and develop use cases for the six permitted uses in the Trusted Exchange Framework for testing.
It is also important to ensure that patient voices are represented and heard, according to the seventh recommendation.
“Unlike other stakeholders who have national associations to represent their interests, there is no widely recognized existing body serving as the voice of the individual/patient,” the TF explained. “The current regulatory and practice shift towards person-centered care, makes it more important than ever that the patient perspective is represented when designing tools and processes to advance interoperability.”
A process that engages patient representatives in data class creation should be developed, and patients should be properly represented throughout each stage of the interoperability testing.
ONC should also support data object harmonization, ensuring there are sufficient resources to enable harmonization to occur at each stage, according to the TF’s seventh recommendation.
“If the National Quality Forum (NQF) has interest in a quality measure that, from inception to mandate, takes 3 years, and in that effort e-measures and corresponding data needs are identified, those should enter the USCDI process at that time and not at the end of the process,” the TF suggested. “In this way e-measures will be more achievable and less burdensome.”
Finally, implementing data class management and a governance structure for which the USCDI must adhere to will be critical, the TF stressed.
“ONC should facilitate work groups when appropriate and help identify and educate stakeholders regarding how to effectively engage with the USCDI,” the recommendation report stated. “The TF recommends that the ONC work closely with the RCE to articulate and measure data classes’ potential net value, technical readiness and adoption level.”