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ONC Finalizes Annual Advisory for Health IT Standards

As part of its effort to advance healthcare interoperability through the adoption of common health IT standards, ONC has issued its latest standards advisory.

By Kyle Murphy, PhD

- The Office of the National Coordinator for Health Information Technology (ONC) has finalized 2017 Interoperability Standards Advisory close to six months after releasing and considering public comments on a draft version published in August.

Health IT standards at ONC

 “The ISA is a key step toward achieving the goals we have outlined with our public and private sector partners in the Shared Nationwide Interoperability Roadmap, as well as the  Interoperability Pledge announced earlier this year,” National Coordinator Vindell Washington, MD, MHCM, said in statement earlier this week. “We incorporated detailed stakeholder feedback to provide a consolidated, public list of standards and specifications that can be put to use to address clinical, public health, and research needs for sharing electronic health information.”

The latest version marks a series of firsts for the annual advisory on interoperable health IT standards. Most notably, the 2017 ISA and subsequent versions will be web-based documents to undergo frequent updates based on updates from standards development organizations to standards and specifications and feedback from stakeholders.

A change noted in the 2017 ISA draft that continues into the final version is the abandonment of the “best available” characteristic when evaluating health IT standards.

“This change, at the recommendation of the Health IT Standards Committee, seeks to address feedback that stakeholders may perceive varied standards and implementation specifications associated with an interoperability need as ‘best’ despite known limitations or low adoption levels,” the document states.

“Further, that the use of ‘best available’ as a general label for all listings in the ISA,” it continues, “would not provide a sufficient pathway for industry input to ultimately distinguish whether one standard or implementation specification listed in the ISA may be more ‘fit for purpose’ and preferred for implementation over another for the same interoperability need.”

In comments to ONC delivered in October, the Healthcare Information and Management Systems Society (HIMSS) criticized this particular decision.

According to the organization, the decision to do away with the use of “best available” when describing health IT standards and specifications “will minimize the importance of the ISA as guidance to the industry, and does little to encourage implementers to adopt and align on the standards identified.” The organization recommended that ONC weigh the value of using “stronger language” to promote the use of established health IT standards and highlight the development of those emerging.

Criticism aside, ONC intends finalized 2017 ISA to serve myriad purposes:

To provide the industry with a single, public list of the standards and implementation specifications that can best be used to address specific clinical health information interoperability needs. Currently, the ISA is focused on interoperability for sharing information between entities and not on intra-organizational uses. 

To reflect the results of ongoing dialogue, debate, and consensus among industry stakeholders when more than one standard or implementation specification could be used to address a specific interoperability need, discussion will  take place through the ISA public comments process. The web-version of the ISA will improve upon existing processes, making comments more transparent, and allowing for threaded discussions to promote further dialogue.

To document known limitations, preconditions, and dependencies as well as provide suggestions for security best practices in the form of security patterns for referenced standards and implementation specifications when they are used to address a specific clinical health IT interoperability need.

The ISA is designed to provide clarity, consistency, and predictability for the public regarding the standards and implementation specifications that could be used for a given clinical health IT interoperability purpose.

The online version of the 2017 ISA is available here.

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