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AHA Offers Interoperability Standards Recommendations to ONC

October 26, 2016
by Rajiv Leventhal
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The American Hospital Association (AHA) has offered feedback to the Office of the National Coordinator for Health Information Technology (ONC) on the agency’s draft Interoperability Standards Advisory (ISA) that it issued in August.

The ISA is a model by which ONC coordinates the identification, assessment and public awareness of interoperability standards and implementation specifications that can be used by the industry. According to ONC, the draft ISA for 2017 remains focused on clinical health IT interoperability and updates and improvements are due largely to recommendations received from public comments and the Health IT Standards Committee. As previously reported by Healthcare Informatics, “At a high level, the most substantial changes between the 2016 advisory and the draft 2017 ISA are largely related to the ISA’s content and framing. ONC is transitioning the ISA from a stand-alone document to a Web-based resource with greater interactive potential.”

In a letter to ONC, on behalf of AHA’s nearly 5,000 member hospitals and other healthcare organizations, Ashley Thompson, AHA senior vice president, public policy analysis and development, urged federal officials to provide more specific information on the characteristics and metrics it has used to assess the readiness of standards and implementation specifications for use in clinical care.

Indeed, with the draft ISA for 2017, ONC discontinued the use of the label “best available” as an overall concept for the ISA to be more inclusive, which was a change recommended by the Health IT Standards Committee. “This change 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,” ONC officials stated in the draft advisory.

As such, AHA urged ONC to prioritize outreach to organizations conducting maturity assessments so that future iterations of the ISA can include this reference. “In addition, the AHA recommends that ONC use the ISA to make publicly available the feedback it receives on the adoption experience of standards and implementation specifications.”

The AHA also recommends that the 2017 ISA also include information on actual standards use in the real world, and not just adoption. The letter read, “The Draft 2017 ISA uses the term ‘adoption level’ to indicate whether a standard has been adopted in healthcare and a graphic to indicate the level of adoption, from low to high, for a particular standard. However, experience to date indicates that a standard may have a high adoption rate as a result of a health information technology (IT) certification requirement, although it does not meet provider needs.”

AHA said in the letter that the Direct standard is a prime example of this misalignment. “Hospitals must ensure that their affiliated physicians and post-acute care partners can receive summary of care documents sent using the Direct standard and a Direct secure email address. Many providers use Direct to share clinical information. But the standard has proven hard to use and does not always support existing clinical workflows,” the letter read.

AHA also offered other recommendations to ONC in the letter, including:

  • Disseminate information about the use of identified standards to support interoperability. The AHA recommends that ONC support the work of private-sector initiatives that are educating stakeholders about the availability and readiness of standards, especially as they pertain to interoperability.
  • Provide additional information on the characteristics of the standards and implementation specifications. The AHA recommends the addition of a hyperlink to information on the standard or implementation specifications that are in the pilot stage of implementation.
  • The AHA recommends that ONC include an additional reference and a hyperlink when a standard or implementation specification is required in federal programs other than those that fall under ONC’s purview.
  • The AHA also recommends that ONC continue to make a static PDF of the ISA available as well as develop an appendix to capture the resources that are linked to the respective characteristic that accompanies each standard or implementation specification.

Based on public comments like these, the draft 2017 ISA will be revised and the final 2017 advisory will be published in December.

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