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How Certification, Testing Impact Health IT Interoperability

By Kyle Murphy, PhD

- Health IT testing and certification are "urgently needed" to advance healthcare interoperability, according to the American Hospital Association (AHA).

AHA comments on certification and testing for supporting health IT interoperability

The organization recently published comments on the 2015 Edition health IT certification rule proposed by the Office of the National Coordinator for Health Information Technology which identified these aspects of health IT infrastructure "as a starting point to improve interoperability."

The letter from AHA Senior Vice President of Public Policy Analysis & Development Linda E. Fishman states that an effective health IT testing and certification process should also involve end users so that hospitals, health systems, and other end users can "better understand what is being tested, and how it is being tested."

According to AHA, health IT testing has far-reaching consequences for semantic interoperability:

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  • Rigorous conformance testing of EHRs and of interfaces to ancillary systems that connect to EHRs (such as laboratory information systems) is urgently needed. It will support greater confidence that certified products may be reliably used to meet regulatory and market requirements. Conformance testing for interoperability also would communicate to vendors that the products required for use in federal programs must have “built in” interoperability, rather than the current scenario in which information sharing is “added on” via multiple point-to-point interfaces post-certification.

    As part of its recommendations for ONC on the subject of transparency, the organization is asking the federal agency maintain a centralized resource for sharing information about the interoperability capabilities of EHR products and vendors.

    "This includes the disclosures proposed in the rule, the findings from field surveillance, and complaints received. ONC should also consider additional transparency metrics about how well EHR products and their vendors support interoperability," Fishman notes.

    The AHA's remarks likewise include concerns about the influence of the EHR Incentive Programs on the ONC's approach health IT certification and testing. As a result, the organization is advocating for the federal agency to recognize the demand for health IT certification of non-meaningful user.

    "From the hospital perspective, certifications that would support information exchange with other care settings that are not part of meaningful use are logical next steps," adds Fishman.

    Allowing for the maturation of health IT standards and application programming interfaces (APIs) round the AHA's comments on the proposed 2015 Edition certification criteria.

    According to Fishman, the immaturity of health IT standards for APIs could lead to the development of one-off APIs and the costs associated with them. The solution for maturing health IT standards is likely to come from piloting these specifications and profiles in real-world settings:

    Federal programs to mature draft standards through pilots or demonstration projects would signal federal support for innovation without imposing an immature standard on the entire provider community. By relying on evidence from real-world pilots that a draft standard can be scaled for ubiquitous use and become a mature standard, the federal government can then use the regulatory process to advance use of the standard, if there is sufficient evidence that regulation is needed.

    The AHA's comments on the proposed rule for health IT certification are line with its comments on the Stage 3 Meaningful Use requirements proposed by the Centers for Medicare & Medicaid Services (CMS). A consistent theme in both sets of comments is the need for a well-informed and reasonable approach to advancing health IT interoperability.


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