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ONC Proposed Rule ‘Turning Point’ for Healthcare Interoperability

The ONC proposed rule supporting the use of the HL7 FHIR standards for healthcare APIs is a “turning point” for healthcare interoperability, judged Intermountain CMIO Stan Huff.


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By Fred Donovan

- The ONC proposed rule supporting the use of the Health Level Seven’s (HL7) Fast Healthcare Interoperability Resources (FHIR) standards for healthcare application programming interfaces (APIs) is a “turning point” for healthcare interoperability, judged Intermountain Healthcare Chief Medical Informatics Officer (CMIO) Stan Huff. 

As part of its recently released notice of proposed rulemaking (NPRM) implementing the 21st Century Cures Act, ONC laid out new API certification criteria, new standards and implementation specifications, and conditions and maintenance of certification requirements. To be certified, healthcare API developers must use the HL7 FHIR standard along with implementation specifications. 

“I think those are good provisions. They're going to require work; everybody's not doing that yet. But I think it's a very positive step forward,” Huff told HITInfrastructure.com

Huff stressed that interoperable healthcare APIs will have a “tremendous” impact on healthcare. “That impact is really the reason that I'm so interested in standards and in interoperability.”

He related that he has been involved from start in the development of the HL7 FHIR standards and the FHIR APIs, and his organization has developed FHIR APIs.

Huff explained that the HL7 FHIR standards are already in use in many healthcare organizations for transmission of lab data, orders, and prescriptions.

Healthcare interoperability will help reduce patient deaths caused by preventable medical errors, which he estimated at 250,000 deaths per year.

“We can save the lives of patients by implementing advanced clinical decision support, for example, to detect occult sepsis or to help diagnosis and management of pulmonary embolism. But that can’t go anywhere because the infrastructure in every system is different,” he said.

Interoperability would also help lower costs from sharing and using data. “The whole healthcare enterprise nationwide and worldwide could become a learning health system because interoperability enables data to be shared seamlessly,” he said.

Also, interoperability would enable the sharing of data for public health to detect outbreaks and other unforeseen public health developments, he noted.

“If we realize the vision of interoperability, it means that essentially there could be an app store for healthcare, much like there is for iPhone or Android phones. I see that as a real enabler of mobile computing for healthcare,” he added.

The healthcare industry should work toward the highest level of interoperability, plug-and-play interoperability, which “can be truly market changing,” Huff said.

The Center for Medical Interoperability, located in Nashville, in one organization that is working to promote plug-and-play interoperability. The center’s members include LifePoint Hospitals, Northwestern Memorial Healthcare, Hospital Corporation of America, Cedars-Sinai Health System, Hennepin Healthcare System, Ascension Health, Community Health Systems, Scripps Health, and UNC Health Care System.

The mission of the center, which brings together public and private hospitals from across the country with $200 billion in annual health IT buying power, is “to achieve plug-and-play interoperability by unifying healthcare organizations to compel change, building a lab to solve shared technical challenges, and pioneering innovative research and development.”

The center stressed that the “lack of plug-and-play interoperability can compromise patient safety, impact care quality and outcomes, contribute to clinician fatigue and waste billions of dollars a year.”

The center operates a centralized testing and certification lab, which is a center of excellence for plug-and-play interoperability. In this lab, the center personnel develop and demonstrate the architectures and interfaces needed to deliver hospital interoperability and connectivity and then test and certify that devices and technologies meet specifications.

In addition, the CommonWell Health Alliance and the Sequoia Project’s Carequality are promoting healthcare interoperability. The majority of EHR vendors with significant market share enable providers to connect with CommonWell or Carequality, according to a recent KLAS report.

Last fall, CommonWell announced its connection to the Carequality framework, making it available to CommonWell members. As a result, CommonWell and Carequality-enabled providers can carry out bidirectional health data exchange to improve care coordination and healthcare delivery.

“We are proud to break down yet another barrier to interoperability by making this much anticipated connection available to our members and their clients,” said CommonWell Health Alliance Executive Director Jitin Asnaani. “This increased connectivity will serve to empower providers with access to patient health data critical to their healthcare decision-making.”


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