Strategic Approach to Standards Needed, Nation’s Health Informatics Experts Say
In comments submitted to Office of the National Coordinator for Health Information Technology (ONC), the American Medical Informatics Association (AMIA) called on the federal government to update and enhance the Nationwide Interoperability Roadmap. The nation’s experts in health informatics also urged ONC to support a more robust, modern testing infrastructure for health IT standards.
These comments were offered in response to a September call from the ONC, which sought comments on its Interoperability Standards Advisory (ISA) in preparation for publication of the 2018 Reference Edition. AMIA recently developed Policy Principles and Positions related to Health IT Data Standards & Interoperability, and used these to assess the larger landscape of health IT standards as represented by the ISA.
“AMIA appreciates the efforts made by ONC to have an open conversation regarding the current state of biomedical data standards,” the group said in comments. “In particular, the annual ISA process has given stakeholders a chance to discuss and debate the current state of standards for specific use cases. While recent enhancements to the content and presentation of the ISA have improved the capacity for stakeholder debate, there remains a need for unbiased, strategic leadership on the current status and future direction of health IT standards. We believe this leadership is best derived from private sector experience, with public investment and convening.”
Using its Health IT Data Standards & Interoperability Principles and Positions to assess the ISA, AMIA did not critique individual standards or sections of the standards catalogue. Rather, AMIA developed recommendations that are “important to ensure that any standards referenced in the ISA will be used consistently and prudently towards the goal of interoperability.”
Specifically, AMIA called on ONC to establish a dedicated roadmap for standards, including development of a framework for how multiple standards should fit together to support interoperability for important, national uses cases, and the broader health IT ecosystem, which will include research and consumer products. The organization pointed towards the Nationwide Interoperability Roadmap as a starting point to enhance our national health IT strategy.
“Innovation depends on interoperability, and interoperability depends on the use of quality standards,” said Douglas B. Fridsma, MD, PhD, FACP, FACMI, AMIA President and CEO. “To make the ISA impactful we need an overarching framework, similar to the Internet Protocol stack. Once established, this standards framework will enable the private sector to innovate in all directions.”
“For the past several years we’ve made tremendous progress on health IT standards, which has had a significant impact on patient care,” said Thomas Payne, MD, FACP, FACMI, AMIA Board Chair and Medical Director of IT Services at the University of Washington’s UW Medicine. “But now we must learn from lessons past, and take a more intentional approach to how we develop standards, test standards, and combine standards for implementation and use.”
Another aspect of our current health IT standards landscape involves whether and how standards are tested, AMIA said. “Thorough testing remains an unrealized aspect of our nationwide approach to standards,” the group said in comments. “Very few standards undergo rigorous testing at the development-level or at the implementation-level. Both are critical if interoperability is to occur.”
AMIA noted that ONC’s Certification Program has relied on conformance testing – testing whether systems use a specific standard – not true interoperability testing, which would test both the sending and the receiving of information. “In our experience,” AMIA said, “this is a daunting problem that warrants prompt attention from ONC and standards development organizations.”
Lastly, AMIA advocated for public support for standards development. “As a foundational principle, AMIA believes that health IT interoperability provides an enormous positive impact on society. Thus, AMIA recommends adequate funding for the development, management, testing, and maintenance of HIT standards, as well as the SDOs that create them. Sufficient and sustained investment by the federal government is necessary for interoperability to be achieved nationwide.”
Click here for AMIA’s full comments.