AMIA seeks better standards testing, update to interoperability map

The nation needs a more robust and modern way of testing healthcare information technology standards, as well as an update to plans for the interoperability “roadmap” it’s following to improve the exchange of medical information.

Those suggestions are among several offered by the American Medical Informatics Association (AMIA) in a comment letter sent this week to the Office of the National Coordinator for Health Information Technology.

AMIA, in responding to a request for comments on ONC’s Interoperability Standards Advisory (ISA), went beyond merely discussing provisions of the advisory to add the organization’s thoughts on the direction of interoperability within the healthcare industry.

“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,” said AMIA’s letter to Don Rucker, MD, national coordinator for health information technology. “We believe this leadership is best derived from private sector experience, with public investment and convening.”



AMIA is asking ONC to establish a dedicated roadmap for standards, including development of a framework for how multiple standards should fit together to support interoperability, both for national use cases and the broader health IT ecosystem, which it considers to include research and consumer products.

Also See: ONC to tackle barriers to EHR usability and interoperability

The organization said the Nationwide Interoperability Roadmap could be a starting point to enhance the national health IT strategy. It calls for ONC to adopt three recommendations to achieve the full potential of interoperability:

* Updating and enhancing the interoperability roadmap, including “a detailed gap analysis of current and potential standards to address priority national use cases.”

* Enhancing testing and improving test tools to ensure standards actually enable progress. “Very few standards undergo rigorous testing at the development level or implementation level,” AMIA’s letter states. “Both are critical if interoperability is to occur.”

*Investing and aligning funding toward the goal of improved standards. “As the national dialogue continues in the direction of information models and the use of ever-more nuanced vocabularies for various use cases, we recommend that ONC coordinate investment in terminologies and reference standards that might be used in combination,” the organization suggests. “AMIA recommends adequate funding for the development, management, testing and maintenance of HIT standards, as well as the standards developing organizations that create them.”

AMIA leaders say the country needs to take intentional steps to capitalize on standards to achieve easier and more useful information exchange.

“Innovation depends on interoperability, and interoperability depends on the use of quality standards,” said Douglas B. 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 standard framework will enable the private sector to innovate in all directions.”

“For the past several years we’ve made tremendous progress on health IT standards, which has had a significant impact on patient care,” said Thomas Payne, MD, AMIA’s board chair and medical director of IT services at the University of Washington’s UW Medicine. “But now, we must learn from lessons past, and take a more intentional approach to how we develop standards, test standards and combine standards for implementation and use.”