International Health IT Standards: A Closer Look at ONC Efforts

Dr. Doug Fridsma | January 24, 2013

Last week, I highlighted the work ONC does with the international health IT community at a broad level.  Today, I’m going to do a “deeper dive” into some of the specifics.  It’s important to note that in all of our international efforts we have worked to align our domestic priorities with the international health IT community. Much of our standards work focuses on an international set of “building blocks for interoperability” that aligns with our domestic portfolio of national health IT standards.

How ONC is Encouraging International Health IT Standards

ONC is engaged in a number of efforts to promote international health IT standards. Some of those efforts include:

1.     Defining an International Vocabulary for Health Terms & Products

ONC is working with the National Library of Medicine and with the epSOS External Links Disclaimer project to identify a subset of the international vocabularies for medications, problems, administrative and disease monitoring, and laboratory tests that can serve as a draft international standard for medical concepts. This serves to help bridge language differences and recognize a common subset of these vocabularies for international use.

2.     Standardizing Healthcare Summary Documents

ONC is working to analyze the different content standards for healthcare summary documents used in the United States and in the European Union (EU). We hope we can leverage work in the EU and the consolidated CDA to get agreement on an internationally recognized way to structure healthcare summary documents.

3.     Increasing Patient Access to Their Health Information Internationally

ONC is developing approaches and policies that allow for patient-mediated or provider-mediated exchange of information. This means making sure that patients have access to their own health information. While we enjoy such rights in the United States, this is by no means an international right. But, patient access to health information is important. And it is important to create a path that allows not only provider- or organizational-mediated health information exchange (like the EpSOS project), but also provides for patient-mediated exchange. This will help to accelerate the sharing of health information while the privacy and policy differences across different countries can be explored.

Challenges to Encouraging International Health IT Standards and Adoption

Collectively, we have identified additional issues that international countries on both sides of the pond need to address to accelerate health IT standards development and  adoption:

1.     A Consistent Health IT Standards Framework to Build Upon

We need to develop a consistent technical and standards infrastructure to support the ongoing maintenance and development of health standards for vocabularies, structures, and services. For example, the CTS-2 standard, developed by HL7, provides a suite of standards for sharing vocabularies and value sets across different health IT systems, and provides a way to federate the development of common vocabularies both within a country, but internationally as well.

2.     An Increasing Demand for International Health IT Professionals

We will need an educated workforce to support the deployment and use of health IT. With the EU presidency transferring to Ireland in 2013, there is renewed interest in this activity internationally.

Roadmap for International Health IT Collaboration

ONC  recently published a shared roadmap for health IT between the United States and the EU and anticipate more discussions in the spring when the Irish Republic hosts the next internal eHealth week in Dublin.

And, it can be surprising where the work of the S&I framework shows up. Last year, I went to New Zealand to participate in a technical discussion of health IT standards and the work that the United States was doing for meaningful use. I had never been to New Zealand, and after nearly 24 hours in a plane, I arrived at the Ministry of Health for my meetings. This country, thousands of miles away, was standardizing their clinical content to the S&I framework-developed consolidated CDA.  The dedicated work of the S&I community was being noticed half way around the world!

Opportunities for International Health IT Standards Collaboration

We have a number of opportunities for international health IT standards collaboration including:

  1. Collective investments by governments – to help accelerate the process, streamline investments, and lower costs for vendors to access a broader marketplace.
  2. Learning what works (and what doesn’t) – to form  standards, interoperability, and health IT infrastructure.
  3. Use health IT standards – to provide more opportunity for domestic companies to reach international marketplaces and export their innovative health IT technology.

It’s important to recognize that the international health IT community is watching what we are doing in the United States  with the meaningful use program. While we are working hard to develop standards-based, interoperable health IT,  we are not developing technology for technology sake: we are doing so in service to improve patient care quality, access and outcomes.

While we see the health IT standards like DIRECT, Blue Button, and CCDA being “exported” and used internationally, perhaps the most important export that comes from ONC may be Meaningful Use itself.

Next week: S&I Framework Update: The Structured Data Capture Initiative

Read other blogs by Dr. Fridsma on standards development and harmonization, coordination of federal and private efforts toward interoperability and health information exchange, and health IT innovations.