Three ways ONC can improve healthcare interoperability


The American Medical Informatics Associations says interoperability has fallen off as a priority at the ONC. Here are its top recommendations to the organization.

Finding solutions to healthcare’s interoperability problems continues to be a challenge considering the multiple stakeholders involved in the information highway. But one organization says that interoperability has fallen off as a priority at the HHS Office of the National Coordinator for Health Information Technology (ONC).

Though interoperability standards exist, the healthcare industry still has a lack of uniformity, said Douglas B. Fridsma, MD, PhD, FACP, FACMI, president and CEO of the American Medical Informatics Association (AMIA), in a letter to the ONC.

“Despite the critical role of standards in system interoperability and data exchange, as well as widespread recognition of their importance, the uptake of standards in healthcare is varied and incomplete,” Fridsma said in the letter that included comments to improve the 2018 Interoperability Standards Advisory Reference Edition.

Biggest interoperability problems

One problem identified by AMIA is a lack of clear and unbiased leadership in making interoperability a reality in healthcare, according to Fridsma. He adds that “leadership is best derived from private sector experience, with public investment and convening.”

Other problems plaguing the advancement of interoperability include multiple coding systems, competing standards, and gaps in clinical standards used to exchange information, according to the AMIA letter.

Three AMIA recommendations

AMIA recommended three changes to the ONC in order to advance interoperability:

1.     Update and enhance the National Interoperability Roadmap.

The recommendations lead with updating the Shared Nationwide Interoperability Roadmap, which the ONC created in 2015. AMIA recommends a two-pronged approach to making updates. First, a gap analysis between the current standards and the goals would help ONC prioritize and remove goals that aren’t working. Second, cases based on cases and national priorities can help create more meaningful standards.

“For example, if controlling the opioid epidemic is a national health priority, then our standards and roadmap should include ubiquitous, API-based access to prescription drug monitoring program information for opioids across institutions,” Fridsma said.

2. Enhance testing and improve test tooling

Creating true interoperability testing is “critical,” Fridsma said. Rigorous testing when developing and implementing new standards, particularly by both sending and receiving information, would be a practical enhancement, he said.

He cited the clinical document architecture validation tools and practices that make content and technical quality of patient records more robust, as a step in the right direction. “But we need a more robust, modern testing infrastructure for health IT standards,” he said.

3. Invest and align funding to improve health IT standards

AMIA also suggests that the ONC allocate more money to developing, maintaining, and testing technology that would increase interoperability. Specifically, terminology and reference standards are requested to make national dialogue easier.

“Another option would be to coordinate across federal agencies and offices that rely on or reference health IT standards. Regardless, sufficient and sustained investment by the federal government is necessary for interoperability to be achieved nationwide,” Fidsma said.

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