The Office of the National Coordinator for Health IT (ONC) has finalized its self-described catalog of “best available” health IT standards and implementation specifications. ONC says the 2016 Interoperability Standards Advisory (ISA) has been “significantly expanded and updated” compared to the inaugural advisory issued last year.
“These updates and improvements are largely due to the two rounds of public comment and recommendations from the HIT Standards Committee,” according to the document’s preface.
ONC set forth ISA’s three primary purposes as follows:
“1. To provide the industry with a single, public list of the standards and implementation specifications that can best be used to fulfill specific clinical health information interoperability needs.
2. To reflect the results of ongoing dialogue, debate and consensus among industry stakeholders when more than one standard or implementation specification could be listed as the best available.
3. To document known limitations, preconditions and dependencies as well as known security patterns among referenced standards and implementation specifications when they are used to fulfill a specific clinical health IT interoperability need.”
The big changes within the 2016 edition are structural, to flesh out the ISA’s depth and breadth. “Most notably, the 2016 Advisory includes six informative characteristics for each standard and implementation specification referenced. We believe that these characteristics will help provide stakeholders with more context regarding the relative maturity and adoptability of standards and implementation specifications,” wrote Steven Posnack, director of ONC’s Office of Standards and Technology, and Chris Muir, director of ONC’s HIT Infrastructure and Innovation Division, in a Dec. 22 post on the agency’s Health IT Buzz blog.
Posnack and Muir also noted that the published characteristics set a baseline for comparison 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.”
In addition, the introduction to each section in the 2016 edition includes a statement of “interoperability need” — an outcome stakeholders would want to achieve.
Here’s how a generic entry appears, with the six characteristics — Standards Process Maturity, Implementation Maturity, Adoption Level, Federally Required, Cost and Test Tool Availability — listed horizontally at the top of each individual entry:
Note that the “Adoption Level” characteristic conveys ONC’s analysis of a standard or spec’s “approximate and average adoption level in healthcare within the United States,” based on, but not limited to: “(1) 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; (2) feedback from subject matter experts; and (3) public comments.”
Here’s the ISA’s entry for the category of representing clinical health information as a resource:
The ISA’s scope is limited strictly to clinical health IT systems’ interoperability. It includes electronic health information “created in the context of treatment and subsequently used to accomplish a purpose for which interoperability is needed (i.e., a referral to another care provider, public health reporting).” It does not include “administrative/payment-oriented interoperability purposes or administrative transaction requirements that are governed by HIPAA and administered by the Centers for Medicare and Medicaid Services.”
Public comments on the 2016 ISA were accepted for a 45-day period that ended on Nov. 6. ONC used those comments — as well as comments on the 2015 edition — to formulate the final 2016 version. ONC also incorporated recommendations from the HIT Standards Committee. The comment period on the 2016 edition will begin early in the new year, according to ONC, and will be used to inform development of the 2017 version.