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Updating Progress of FHIR, C-CDA Health IT Standards at ONC

The two health IT standards feature prominently in recent developments at the federal agency.

By Kyle Murphy, PhD

The Office of the National Coordinator for Health Information Technology (ONC) is making headway in promoting two health IT standards.

First up, the Fast Healthcare Interoperability Resources (FHIR). On Monday, the federal agency announced the Phase 1 winners of the Consumer Health Data Aggregator and Provider User Experience Challenges.

As noted in the ONC announcement, the purpose of the challenges was to " electronic health information stored in EHR and health IT systems easier to access and use for both consumers and providers" through the use of FHIR and other open application programming interfaces (APIs).

Each challenge had four winners, each slated to receive $15,000 awards. FHIR played a prominent role in four of the eight total winners as far as the descriptions of the projects are concerned. Three came from the ONC Consumer Health Data Aggregator Challenge:

Green Circle Health: The Green Circle platform intends to provide a comprehensive family health dashboard covering the full Common Clinical Data Set and using FHIR to transfer patient information. It will also incorporate patient-generated health data from wearables, sensors, and other connected devices.

HealthCentrix: The Prevvy Family Health Assistant app suite provides the capabilities to manage an entire family’s health and wellness, including targeted information exchange. The platform incorporates both FHIR and Direct messaging with EHRs certified to Meaningful Use Stage 2.

Medyear: Medyear’s mobile app utilizes FHIR to merge a patient’s records from multiple sources into one clean interface. It borrows a social media-like newsfeed style to show real-time EHR updates and provides easy functionality to message and call clinicians.

The other come by way of the ONC Provider User Experience Challenge:

Herald Health: the Herald platform leverages FHIR to highlight the patient information that clinicians need the most. Its integration of FHIR will help enable highly customizable, IFTTT-like (“if this, then that”) alerts based on real-time EHR data.

In March, National Coordinator Karen DeSalvo, MD, MPH, MSc, announced the software app challenges as part of the federal agency's program, Connecting and Accelerating a FHIR App Ecosystem.

“This strategy will help us reach the consumer and provider-friendly future of health IT we all seek,” she said at the time. “It reflects our guiding principles that consumers and providers should have easy, secure access to health information and the ability to direct that information when and where it is needed most.”

The impetus behind the use of FHIR is to strengthen the ability of current EHR technology to share clinical data with other systems and applications, perhaps even giving legs to legacy systems knocked for their closed nature.

The second bit of ONC-related work on health IT standards is the recent beta release of the  C-CDA Scorecard to promote standardization in its implementation, a lack of which has drawn criticism of this health IT standard used as part of the EHR Incentive Programs (i.e., meaningful use).

In conjunction with HL7, ONC has set up the tool comprising best practices and quantitative scoring criteria for end users to test their C-CDA (Consolidated-Clinical Document Architecture) files against the requirements of the 2015 Edition Health IT Certification for Transition of Care criteria. In addition, the system scores C-CDAs based on enhanced interoperability rules developed by HL7 for appropriate coding structure and semantics.

As HL7 CEO Charles Jaffe, MD, PhD, told HealthITInteroperability.com last April, the health IT standards organization has worked to reduce optionality in the development of FHIR, building on the experiences of CDA and C-CDA implementation over previous years.

"We certainly can make it easier by reducing the optionality," he explained. "Then we're stuck with the never-ending complaint that conformance reduces innovation. With FHIR, we can make it sufficiently flexible and yet demand a degree of conformance so that one can assemble resources and put them in any envelope or any rendering tool and still retain the interoperability. That's the objective and why the approach to FHIR is fundamentally different from other specifications."

C-CDA remains a viable health IT standard and is responsible for meaning of the capabilities currently residing in today's certified EHR technology while FHIR remains one health IT standard that federal officials are hoping to see more attention being paid to for the sake of advancing healthcare interoperability.

Dig Deeper:

Why Health Data Interoperability is Setting EHR Vendors on FHIR
What FHIR Has Learned from Past Interoperability Failures




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