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ISA’s Annual Review Period Promotes Interoperability Advancements

The ISA's latest comment and review period comes to a close as developers and industry experts share their insight on interoperability advancements for next year's advisory updates.

interoperability advanvcements

Source: Thinkstock

By Elizabeth O'Dowd

- The Interoperability Standards Advisory’s (ISA) annual comment and review period comes to a close at 5 pm, ET, on October 1. The process began to help determine how the National Coordinator for Health Information Technology (ONC) will implement specifications for the healthcare industry to exchange data and promote interoperability advancements.

“The reviews will help the ONC coordinate the identification, assessment, and public awareness of interoperability standards and implementation specifications that can be used by the healthcare industry to address specific interoperability needs including, but not limited to, interoperability for clinical, public health, and research purposes,” explained the ISA.

The ONC encourages all stakeholders to implement standards for interoperability that are identified by the ISA so data exchange within and among healthcare organizations can be done smoothly and with minimal adjustments.

The ISA is meant to serve at least the following purposes:

  1. To provide the industry with a single, public list of the standards and implementation specifications that can best be used to address clinical health information interoperability needs. Currently, the ISA is focused on interoperability for sharing information between entities, not on intra-organizational uses.  
  2. To reflect the results of ongoing dialogue, debate, and consensus among industry stakeholders when more than one standard or implementation specification could be used to address a specific interoperability need, discussion will take place through the ISA public comments process. The web-version of the ISA improves on existing processes, making comments more transparent, and allowing for threaded discussions to promote further dialogue.
  3. To document known limitations, preconditions, and dependencies as well as provide suggestions for security best practices in the form of security patterns for referenced standards and implementation specifications when they are used to address a clinical health IT interoperability need. 

The ISA takes feedback from public comments and subject matter experts and uses that feedback to advise about changes and improvements to interoperability standards. These improvements can be found on the recent updates pages of the ISA.

READ MORE: FHIR May Not Help Healthcare Orgs Achieve Semantic Interoperability

The scope of the ISA includes electronic health information that has recently expanded to include efforts to increase public health and research interoperability. The ISA has also made efforts to expand to cover where interoperability is needed in the context of care referral to another care provider and public health reporting. The late 2017 updates now include interoperability for needs related to healthcare administrative functions as well.

“The ISA is designed to inform standards and implementation specification choices for all types of health IT that support interoperability needs, not solely electronic health record (EHR) systems,” said the ISA.

“Furthermore, the ISA is not intended to imply that health IT systems need to support all of the listed standards and implementation specifications. Rather, in the event that a health IT developer or healthcare provider seeks to address a particular interoperability need, the ISA should serve as the first resource consulted to inform the selection of standards and implementation specifications.”

“Additionally, the ISA is designed to inform the ‘what’ that could be used to address an interoperability need in order to assure industry consistency around standards selection and is not mean to explicitly direct ‘how’ the standards and implementation specifications would be implemented to address an interoperability need (e.g., application programming interface or conversion tools).”

Interoperability standards are becoming more complex as healthcare organizations integrate applications into their IT infrastructure that use data from EHRs and other data sources. Many organizations find that they are restricted in sharing data because of proprietary tools that can’t talk to each other, preventing them from exchanging data in a meaningful way.

READ MORE: How Will Amazon, Google, Microsoft Impact EHR Interoperability, FHIR?

The interoperability issues the ISA addresses are also being examined by outside organizations. For example, Google, Amazon, and Microsoft have recently acknowledged the importance of standardized interoperability in healthcare.

While from a traditional business standpoint forcing organizations to continue to use the same vendor because they can’t successfully integrate data with new systems makes sense, it does not help the continued advancement of healthcare.

“You can compare it to the web standard world,” Redox Senior Developer Nick Hatt explained to HITInfrastructure.com. “Microsoft, Google, and Apple all make competing browsers for market share in the browser space, but they can all agree on HTML and they can all agree on JavaScript. These companies participate in those standards, but they want to compete on the implementation and not on the standard.”

Taking feedback from industry professionals and making that feedback available will help healthcare developers integrate interoperability more easily into their healthcare organizations. The more easily information can be exchanged the more actionable it can be for future analytic and population health projects. These projects then can lead to the better understanding of patient conditions and eventually a better standard of care.


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