- ONC recognizes the need to push nationwide interoperability further to the forefront of health IT infrastructure.
The federal agency recently published a Proposed Interoperability Standards Measurement Framework to assess the healthcare industry’s progress toward implementing health IT interoperability standards and their use in measuring advancement.
ONC sees this undertaking as a way to guide the evolution of the Interoperability Standards Advisory (ISA), inform updates to the ONC Health IT Certification 3 Program, and influence stakeholder decision-making.
At present, interoperability measurements standards vary between stakeholders. The lack of consistency poses difficulties when attempting to track the progress of health IT interoperability on a national scale.
ONC points to two primary factors inhibiting health IT developers from properly measuring implemented standards:
Lack of information: Developers may lack up-to-date information on which version of their product a client has implemented. Locally-deployed/client-server products, for instance, often give control to users to determine if and when to upgrade to a new version. Users sometimes skip versions if they do not see sufficient value in the latest upgrade. While developers often receive information that an upgrade has been completed, the information appears to be imperfect.
Indirect sales: Sales partner relationships also factor into the accuracy of information available to the developer. For example, resellers may not notify the health IT developer when the reseller’s clients upgrade product version
In addition to these complicating factors, the way standards are used for health data exchange differs considerably. Health IT developers and healthcare organizations — health information exchanges (HIEs), regional health information organizations (RHIOs), etc. — are applying standards differently which poses difficulties when trying to gather consistent information across the industry.
ONC highlights four areas causing variations in information measurement standards:
Architecture: The architecture (i.e., cloud versus client-based, federated versus centralized, exchange networks provided by developer or a partner organization) of the product or network can impact how and what information can be tracked. System or network architecture can drive what is able to be electronically tracked centrally and the level of flexibility to track new items.
Development decisions: Health IT developers have made differing decisions about the comprehensiveness and level of granularity to build into their measurement capabilities.
Access to the data: Where capabilities have been built into a product to measure end user utilization of the standards, sometimes only the end user or health IT developer can access the information. In other instances, the health IT developer has created a mechanism to centrally track the information.
Variability in standard implementation: Variability in how a standard is used in the field can also cause one developer’s health IT system to not be interoperable with another health IT developer’s system that has implemented the same version of the standard.
Through discussions with various stakeholders, ONC determined optimal ways to implement interoperability standards by health IT developers and end users.
“The objective to measure interoperability standards implementation of a product focuses on understanding a standard’s lifecycle, which refers to the process by which standards are developed, implemented, and then subsequently used,” stated ONC.
Health IT developers should start by reporting which health IT standards are in their development plans and the purpose of these plans.
Next, developers and networks for health data exchange should report which standards they have implemented into versions of their products not already listed in the ONC Certified Health It Product List.
Finally, ONC states health IT developers should report the number of end- users that have deployed a product version with a standard implemented.
Measuring how interoperability standards are used will entail reporting the percentage of end-users utilizing a particular standard, the volume of transactions by standard, the conformance and customization of standards after implementation.
To ensure the framework reflects the interests and priorities of healthcare providers, payers, ONC is opening the framework to public comment.