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ONC Updates ISA Reference Edition on Healthcare Interoperability

ONC has released its updated healthcare interoperability standards, incorporating industry feedback into the 2019 Interoperability Standards Advisory (ISA) Reference Edition.

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Source: Thinkstock

By Fred Donovan

- ONC has released its updated healthcare interoperability standards, incorporating industry feedback into the 2019 Interoperability Standards Advisory (ISA) Reference Edition.

ONC solicited industry feedback on the draft ISA Reference Edition, culled through 74 comments containing nearly 400 recommendations, and updated it based on the comments, explained a blog post coauthored by Steven Posnack, executive director of the Office of Technology, Chris Muir, director of the Standards Division, and ONC staff member Brett Andriessen.

Changes made to the 2019 ISA Reference Edition include the following:

  • Added RSS feed functionality to allow industry to track ISA revisions in real time
  • Changed the structure from lettered subsections to an alphabetized list and relocating models and profiles from Section IV to an appendix
  • Moved unique device ID from Section I to Section II
  • Revised interoperability need titles to better reflect their uses and align them with overall ISA best practices
  • Added several new interoperability needs, including representing relationship between patient and another person, such as a provider, caregiver, or family member; prescribing using weight-based dosing, request for additional refills, etc.; and operating rules for claims, enrollment, and premium payments
  • Included more granular updates such as standards, updated characteristics, and additional information about interoperability needs

The ISA reflects recommendations from the Health IT Advisory Committee and includes an educational section that helps explain interoperability terminology.

“The ISA should be considered as an open and transparent resource for industry and reflects the latest thinking around standards development with an eye toward nationwide interoperability,” the ONC officials wrote.

The Recent ISA Updates webpage provides a summary of recent major changes to the ISA. In January, a new interoperability need, which allows a prescriber to send a prescription to a pharmacy for a controlled substance, was added to Section II: Electronic Prescribing.

Also this month, a new Appendix IV was added to the ISA providing links to state and local public health agencies and their interoperability programs.

Last fall, a number of changes were made to address public comments about ISA received by ONC.

Interoperability needs were added for representing relationship between patient and another person; allowing a pharmacy to request a new prescription for a new course of therapy or to continue therapy, request, respond to, or confirm a prescription transfer, request additional refills, and/or prescribe medication using weight-based dosing; and operating rules for claims, enrollment, and premium payments and to support electronic prescribing transactions.

“The ISA should be considered as an open and transparent resource for industry and reflects the latest thinking around standards development with an eye toward nationwide interoperability.”

Last month, National Coordinator for Health IT Donald Rucker appeared before a House Energy and Commerce Committee health subcommittee hearing on implementing the 21st Century Cures Act.

Rucker told the subcommittee that modification to the 2018 Reference Edition added health information categories, such as pregnancy status, care plans, patient identification, public health reporting, and provider-to-provider communication. In addition, the Reference Edition had endorsements of 151 health information standards covering more than 60 interoperability needs, including clinical, public health, and research purposes.

Rep. Michael Burgess (R-TX), chairman of the House Energy and Commerce Committee’s health subcommittee, said he was “extremely disappointed” that information blocking regulations had not yet been implemented two years after passage of the 21st Century Cures Act.

“It is hard to explain to people that Congress provided the tools necessary for doctors and patients to better coordinate their care through the sharing of patient data, but nothing has changed,” Burgess said.

Rucker responded that the process has taken so long because of the “significant stakeholder outreach” that has included more than 150 meetings with key health IT stakeholders.

“We look forward to receiving and addressing any comments that may be submitted, before issuing a final rule,” he noted. The Office of Management and Budget (OMB) is reviewing ONC’s information blocking proposed rule.

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