During this period of continual change, and with the increasing pressure to realize Meaningful Use investments, the Office of the National Coordinator’s (ONC) proposed 2016 Interoperability Standards Advisory (ISA) is positioned to prepare all of us to better support the many transitions underway in the healthcare industry. If you are not familiar with ISA, it represents just a small portion of the great work coming out of the ONC’s Health IT Standards Committee.
Changes in the Draft 2016 Interoperability Standards Advisory
With the draft 2016 Interoperability Standards Advisory, the ONC has recognized that it is critical to arm both new and seasoned players with a better informed view of the available standards across the market and regulatory landscape. While in previous years, the annual ISA did acknowledge the vast amount of available technology standards, it was simply a comprehensive list with links to underlying standards websites.
This provided little or no context about or evaluation of the strength or validity of a standard. Even for experienced Electronic Data Interchange (EDI) organizations such as NaviNet, it has been, at best, difficult to assess the momentum or support to a “new to you” standard when evaluating new markets or emerging standards. Spending precious IT dollars to build out a capability with a standard that is losing market share or not gaining momentum is risky and can be a death knell to a new product or process improvement.
New Multifactor Evaluation of Standards
In order to provide context for available standards, the 2016 ISA seeks to establish a multifactor evaluation based on six informative characteristics. These six characteristics are:
- Standards Process Maturity: Final or Draft
- Implementation Maturity: Production or Pilot
- Adoption Level: 1-5
- Regulated: Yes or No
- Cost: Free or Fee listed
- Test Tool Availability: Yes or No
The richness of the rating will provide healthcare technology consumers with a relevant and realistic categorization of the overall maturity and adoptability of a particular standard. In order to implement the 2016 ISA required hard and unbiased work by both the Interoperability Standards Advisory Task Force and ONC staff to gather this information for comment. Their work will help move healthcare IT forward and both parties deserve to be recognized for the efforts.
HIPAA Regulated Transaction Set Standards Needed
Yet, there is one area of standards that we would like to see ONC expand its coverage: HIPAA Regulated Transaction Set. We believe this is critical for new and experienced vendors, as well as providers and payers, to understand the full spectrum of standards available for HIT and is also necessary for true interoperability. Although there are strengths and weaknesses in existing HIPAA named standards, there are two challenges with excluding HIPAA from the ISA standards evaluation:
- Specific HIPAA standards provide only a partial solution towards full automation of complex, multi-step workflows like authorization and referrals. This impedes the move to fully digitized communication across the continuum of care. Workflows like the X12 278 authorization transaction set would benefit from pairing with more clinical oriented standards like emerging FHIR resources.
- Virtually all provider, vendor and payer organizations have significant intellectual and infrastructure in the X12 standard format currently required under HIPAA, and they have established EDI gateways to support the exchange of this data with partners.
For health care payers and providers it is critical that we bridge the existing investment in X12 EDI and show where we can leverage the strengths of each standard. We have shared some of our concerns about the absence of HIPAA standards from the maturity rating with the ONC team, and encourage you to do the same. Please take the time to review the draft ISA and be on the look out for the draft with comments. This should be made public very soon. Although the public comment period is over, the ONC would still benefit from hearing your feedback.
Broader Standard View Needed for Interoperability
A broader view of all HIT communication standards will empower organizations to leverage all of their strengths as we aim to move interoperability capabilities across our organizations. At NaviNet, we have begun to partner with many of the more advanced vendors, provider, and payer organizations to collaborate and tackle the known challenges with both named standards and emerging technologies like FHIR. As the move to value-based care contracts increases, it will be critical that we clearly understand the interdependence of all of the standards, so solutions can be developed to span across gaps.
Wondering how the ONC's Interoperability Roadmap impacts health plans?