Take a look at what’s happening on the national standards scene. The Interoperability Standards Advisory (ISA) is working on a new interoperability standard for the health care industry under the auspices of the Office of the National Coordinator for Health Information Technology (ONC).
It’s currently slated to roll out in 2017 – being released in December of 2016. In this installment, Tech Savvy reports on the upcoming standard to get an idea of what might be in front of us.
The Bottom Line
The new federal standard from the ONC is currently in final comment mode. It represents the model by which it will coordinate the identification, assessment, and determination of the “best available” interoperability standards and implementation specifications for industry focusing on clinical health IT interoperability needs. (1)
The scope of the ISA includes electronic health information from treatment that is typically part of the Electronic Health Record (EHR) and intended for interoperability when needed. For example this includes clinical data for referrals to other providers and public health reporting. Since the focus is on sharing clinical data only, any payment or transaction requirements governed by HIPAA are not included in the ISA standard.
The ISA states that the current draft standard is not currently complete but plans to incrementally add to the interoperability needs. See the sidebar for what type of clinical information is included in the draft doc.
The main idea is to provide the health care industry with a way to use a public list of standards for best use interoperability. The other main purposes of the new spec is to encourage discussion on when there’s more than one existing standard to include as a way to meet the ISA’s standard. Also, the plan is to include discussion about cybersecurity patterns and implementation specs when used to fulfill clinical health IT interoperability needs.
Characteristics
The main portion of the standard is in the format as shown in Table 1. There are table entries (in rows) for each of the items depicted in the sidebar. The characteristics (columns) of each entry are:
- Standards Process Maturity – indicates final or draft version of the standard cited
- Implementation Maturity – indicates whether the standard cited is in pilot mode or production mode. Often related in terms of SNOMED (Systematized Nomenclature of Medicine) or HL7 (Health Level7) terms.
- Adoption Level – this is a five point scale ranging from <20% adoption (coded as a 1) to >81% adoption levels (coded as 5). This characteristic includes “unknown” as an option.
- Regulated – this characteristic is a yes or no indicating whether this is part of a regulation or required by the Department of Health and Human Services (HHS).
- Cost – lists whether this standard is “free” or comes at a cost.
- Test Tool Availability – this characteristic indicates whether it has a tool to evaluate conformance. Ranging from Yes to a qualified Yes (has a cost associated) to No and N/A.
Finally, the ONC makes it clear that the ISA does not imply that standards listed in one section/characteristic listing will be used when it also is cited in another section. In other words, the ONC is OK with combining standards from more than one section when better to achieve interoperability. As it says in the ISA – to use the “best available standards and implementation specifications.”
Section I: Best Available Vocabulary/Code Set/Terminology Standards and Implementation Specifications (1)
I-A: Allergies
I-B: Care Team Member
I-C: Encounter Diagnosis
I-D: Race and Ethnicity
I-E: Family Health History
I-F: Functional Status/Disability
I-G: Gender Identity, Sex, and Sexual Orientation
I-H: Immunizations
I-I: Industry and Occupation
I-J: Lab tests
I-K: Medications
I-L: Numerical References & Values
I-M: Patient “problems” (i.e. conditions)
I-N: Preferred Language
I-O: Procedures
I-P: Radiology (interventions and procedures)
I-Q: Smoking Status
I-R: Unique Device Identification
I-S: Vital Signs
Section II: Best Available Content/Structure Standards and Implementation Specifications
II-A: Admission, Discharge, and Transfer
II-B: Care Plan
II-C: Clinical Decision Support
II-D: Drug Formulary & Benefits
II-E: Electronic Prescribing
II-F: Family health history (clinical genomics)
II-G: Images
II-H: Laboratory
II-I: Patient Education Materials
II-J: Patient Preference/Consent
II-K: Public Health Reporting
II-L: Quality Reporting
II-M: Representing clinical health information as a “resource”
II-N: Segmentation of sensitive information
II-O: Summary care record
Section III: Best Available Standards and Implementation Specifications for Services
III-A: An unsolicited “push” of clinical health information to a known destination
III-B: Clinical Decision Support Services
III-C: Image Exchange
III-D: Provider Directory
III-E: Publish and Subscribe
III-F: Query
III-G: Resource Location
WORKS CITED
1. Office of the National Coordinator for Health IT. Interoperability Standards Advisory. HealthIT. [Online] 2016. [Cited: September 16, 2016.] http://www.healthIT.gov