AMIA tells ONC not to lose focus on interoperability standards
The American Medical Informatics Association has called on National Coordinator for Health IT Donald Rucker to update the Nationwide Interoperability Roadmap and work toward a stronger infrastructure to support health IT standards.
In response to ONC's request for feedback on its Interoperability Standards Advisory, AMIA made the case that more consistent standards are essential to fostering more widespread data exchange and analytics.
"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," AMIA said. "We believe this leadership is best derived from private sector experience, with public investment and convening."
AMIA doesn't critique specific standards, but instead argues that any standards referenced in the ISA should be used "consistently and prudently towards the goal of interoperability."
In addition, it requests that ONC develop a dedicated roadmap for standards, including a framework for how multiple standards should fit together to support data exchange.
"As you are aware, health IT standards influence and enable capabilities for analytics and knowledge application in this information-intensive era of healthcare delivery," AMIA wrote in its letter to Rucker. "Increased capacity and ubiquitous use of analytics and knowledge-based treatments, in turn, increase the efficiency and effectiveness of healthcare, with great benefit to patients, payers, and public health.
"However, despite the critical role of standards in system interoperability and data exchange, as well as widespread recognition of their importance, the uptake of standards in healthcare is varied and incomplete," AMIA said. "Substantial variation across implementations hampers true semantic interoperability. Multiple coding systems exist, with overlapping content and different structures that are dynamic, voluminous, complex to implement, and difficult to compare.
"Proprietary, idiosyncratic, and custom coding systems remain in many organizations. There are competing standards for certain content areas, while gaps remain in others. There is no shared understanding for how multiple domain standards should be used to support the spectrum of activities across biomedical research, care delivery, and public health, leading to variation in how data are transformed from local coding systems to national standards and vice versa. There is also a gap in defining clinical standards that can be used interchangeably with basic research standards, limiting translational use of research discoveries."
AMIA pointed out that ONC’s Certification Program has focused on testing whether IT systems use a specific standard, rather true interoperability testing – which would test both the sending and the receiving of information.
It also called for public support for standards development, with "sufficient and sustained investment by the federal government" for the development, management, testing and maintenance of IT standards.
"Innovation depends on interoperability, and interoperability depends on the use of quality standards," said Doug Fridsma, MD, AMIA's 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."