Wanted: Feedback on Ways to Measure the Implementation and Use of Interoperability Standards

In our everyday lives standards enable tasks to be completed more efficiently, reduce configuration costs, and add predictability in markets that can help the lower barriers to entry for innovative products. However, experience has shown that just because technology includes “standardized” capabilities they are not necessarily used to their fullest extent nor are they always implemented in a “standardized” manner. From a health information technology (health IT) perspective, this is especially true when other non-standard/non-computable options exist (e.g., fax), business incentives are misaligned, and in cases where exchange partners cannot equally benefit from standardized data exchange (among other reasons).

When it comes to evaluating interoperability from a technical perspective, one “simple” question to ask is: did the people who developed the health IT in use implement the same standards in the same way to solve the same problem? The Interoperability Standards Advisory (ISA) seeks to give some guidance on standards measurement by estimating a standard’s implementation and use in the field. However, for many standards today publicly reported, quantifiable data regarding their implementation and use is often not readily available or regularly tracked. Indeed, measuring for what purposes and to what extent interoperability standards are being implemented and used is of particular importance because it can identify industry trends as well as areas where standardization on its own appears not to be enough to prompt widespread use.

To address this challenge, ONC has released for public comment a proposed measurement framework which seeks to gain consensus on industry-wide measures to assess the implementation and use of standards. ONC recognizes the critical role that health IT developers, health information exchange organizations, and health care organizations will need to play to develop an agreed upon set of measures to assess the implementation and use of standards.

Accurate measurement will require strong support and participation from multiple health IT stakeholders. Your feedback will help us to engage and coordinate with stakeholders, especially those who may be in the best position to contribute data toward industry-wide measures. Ultimately, a finalized measurement framework would enable aggregate, industry-wide statistics that could be used as a resource by all stakeholders to inform business decisions, enrich policy deliberations, and enhance the accuracy of the guidance provided by the ISA.

Your input is critical. Not only will it inform this specific work but also other federal efforts, including ONC’s interoperability measurement more broadly.  ONC is accepting public comment on the Proposed Interoperability Standards Measurement Framework until 5 p.m. ET on Monday, July 31, 2017.


  1. Vivek says:

    IT development in the health industry is appreciable change but its usage should be optimal. I hope we can not fully rely on technology alone, its usage can be optimized under observation of health expert.

  2. Deborah C. Peel, MD says:

    There is NO way HHS/ONC will ever make HIE happen in the US because the data holders will never willingly give data to competitors. HHS built data blocking into HIT by cutting patients out of the loop in 2003 (consent was eliminated so data holders could exchange PHI for TPO w/o YOU! Face facts—what HHS built is a national HIT system that 89% of US patients no longer trust. See: BlackBook survey of 12,090 patients: https://blackbookmarketresearch.newswire.com/news/healthcares-digital-divide-widens-black-book-consumer-survey-18432252 To see trustworthy self-sovereign HIT/EHRs/data exchange watch videos abt HIE-of-One at: https://youtu.be/OH6hsu4A4gE HealthIT designed for surveillance capitalism will never be trusted. Register FREE to attendor watch the 7th International Summit on the Future of Health Privacy June 1-2 in DC: www.healthprivacysummit.org

  3. Wayne Crandall says:

    As with anything, too much is often not the solution. I believe the goal is to help ensure information is accessible and presented in such a way that:

    a) a specialist receives information from another provider and they can receive it an usable form, read it, digest it into their own brand EHR; and

    b) patients can have access to their information

    First we have to understand that EHR vendors need to have their competitive advantages and giving open access can make them vulnerable. Additionally, they each have their own views on how an EHR should work, how the provider should interface with it and how the information is to be stored. There are wide variances here that affect the data compatibility.

    There are 2 things that need to be solved:

    1. fax has to stop being the requirement for communications. Secure email has to be the form of communications first and foremost. Especially for patients as they do not have access to fax machines easily and faxing is a productivity burn for practices. secure email attachments that are password protected need to be the standard.

    2. for EHR data compatibility – the only standard that needs to be delivered (and therefore will not need to be monitored) is a standard such as used in MS Excel. A standard output format is needed that allows an EHR vendor to output their information in this standard format and the receiving EHR vendor imports the data into their EHR using this standard format – just like tab delimited text or some form similar that deals with all the various data elements of a patient note. Another example is a .csv file – data in this form can be ported to any type of program that supports this file structure.

    Government ofter try’s to solve the entire problem without first taking smaller steps to accomplish the same goal. Also, from a providers perspective – speed is not the goal. the challenge with MU is that the law required practices to achieve goals in a certain amount of time – this caused practices to rush to implement and did not take the time to train and therefore providers are having issues adopting EHR practices to meet guidelines. now because practices rushed to implement EHRs, they chose their vendor at the time unwisely and now the EHR industry is going through a replacement plan as they understand their own needs.

    Providers have little time as it is, just ask a pharm representative – providers are treating patients and often don’t have the time to do administrative things – but it is being forced on them and thus according to the AMA study, 48% of a providers time is now spent on admin!

    in any case, one person’s opinion

    I think the government needs to spend time getting control and best practices for insurance companies because the medical community cannot afford to stay in business at the reimbursement rates. In addition, the efforts, hoops and obstacles a patient has to go through to get their issues that were prescribed or planned by the physician only to be denied by the insurance company is defeating! And there is discrimination by an insurance company when they reimburse an NP at 65% of what a Dr. receives for the very same office visit procedure – who is monitoring this??

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