Standards Are Not Optional

Dr. Doug Fridsma | December 7, 2011

Recently we’ve heard that we need to reduce optionality in the standards being developed as part of the Standards & Interoperability (S&I) Framework, and we are listening to the health information technology (health IT) community.

Reducing optionality improves interoperability and lowers the cost for vendors to implement, thus lowering the cost for health care providers as well. ONC is identifying the vocabularies, the message, and the transport “building blocks” that will enable interoperability. While vendors should be able to flexibly combine them to support interoperable health information exchange (HIE), these “building blocks” need to be unambiguous and have very limited (or no) optionality.

Over the summer, the health IT community has made significant progress with various S&I initiatives in the ongoing journey toward interoperability. Here are some technical highlights:

  1. The Transitions of Care (ToC) initiative has reduced optionality compared to the C32, and improved the clarity of the implementation specification of the consolidated CDA HL7 standard. (For those reading this who are not steeped in the standards world, a C32 is a summary document that includes a patient’s administrative and clinical data. ‘CDA’ refers to Clinical Document Architecture, a standard that specifies how documents should be structured for exchange.) This initiative community boasts 150 participants, and has arrived at broad agreement on the path forward, with the implementation community guiding the pilot process. The ToC Clinical Information Model is being piloted in Q4 2011, through collaboration with State HIE and Beacon programs. We also have a commitment from electronic health record (EHR) vendors to pilot and test the new consolidated CDA Templates during Q4 2011. Finally, the community is continuing to target simpler implementation specifications in 2012.
  2. The Lab Results Interface (LRI) initiative has created a single lab result specification from the ELINCS project and the HITSP implementation guides, both based on the HL7 2.5.1 standard. (ELINCS is a national lab data standard for EHRs.) Combining these two specifications results in the best of both worlds: increased flexibility and increased interoperability. There is consensus by a broad and deep community of 90 active participants that this guide is the right direction for the country. This includes support from proponents of ELINCS and HITSP IGs, clinical laboratories, LIS/EHR vendors, industry associations, government agencies, and numerous other clinical and technical experts.
  3. The Modular Specifications project has identified two ways to transport information and has created more modular, substitutable specifications. Utilizing Direct specifications as the foundation, the project has created a Secure Transport specification based on SMTP and S/MIME and XDR and XDM Conversions. A second approach leverages Exchange specifications as a basis, and a Web services approach has been specified as SOAP over HTTP. From the multiple transport standards, two building blocks are now part of our standards portfolio.

The HIT Standards Committee has also helped reduce optionality among health IT standards:

  1. Based on the work of the Surveillance Implementation Guide Power Team, the HITSC recommended a single standard for public health reporting: HL7 2.5.1. This applies to electronic lab result reporting, immunization reporting, and syndromic surveillance reporting. HITSC recommended that over time, all public health reporting should migrate to this single standard.
  2. The Clinical Quality Measures Workgroup (CQMWG) and Vocabulary Task Force (VTF) jointly developed recommendations for a single vocabulary for each of the administrative, clinical, laboratory and medications domains.

For more information on these HITSC recommendations, please visit

The Office of Standards of Interoperability and the HIT Standards Committee are listening to the health IT community. While there is still much work to be done, we are making tremendous progress toward interoperable health information exchange. As always, we are looking for volunteers to help us as we refine our standards.

Please visit to find out how you can become involved in these initiatives that are helping make interoperability a nationwide reality!