ONC Publishes Interoperability Roadmap, New API Standards

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After months of increased pressure from industry groups and Congress, ONC has published a draft version of its ten-year interoperability roadmap. The draft is open for public comment for the next 60 days, after which the comment period will end and a final draft will be prepared. The plan outlines a sweeping transition toward data portability that ONC will roll out gradually over the next ten years.

In the near term, the roadmap calls for a set of core APIs to be established to support data exchange. These APIs will be supported with standard SOAP and RESTful implementations to send, receive, and query patient records within the various data sets emerging across the industry. Before data extracted from hundreds of millions of patient records can be accurately and reliably transferred between hundreds of different systems, the problem of patient identification and exchanging data in an environment without a national patient identification number needs to be addressed. To support patient identification, ONC is starting with recommendations made in a 2011 HIT Standards Committee report that calls for any API messages to include a supplementary 11-item list of patient identifying information, including name, gender, address, and phone number. Beyond this, ONC has acknowledged that data quality remains a real problem that will hamper national interoperability. Ensuring that the various “data holders” maintain up-to-date demographic information is an issue that nearly all HIE organizations have raised, and is one that the industry has yet to respond to with an effective best-practice solution.

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The guideline goes on to define the data sources that will be referenceable through the new APIs, and the “data holders” that will need to make the new APIs available. The current list, called the “common clinical data set,” focuses on traditional primary and secondary care data items such as medications, problems, allergies, laboratory results, immunizations, and notes. Future iterations could provide an avenue for exchanging patient-generated health data, such as daily activity levels and sleep patterns. ONC will take on the responsibility of publishing an annual update to the common clinical data set that will establish the data items to be exchanged over the API and ensure that the vocabularies being used to exchange each data item are standardized.

For digital health startups, there are some promising use cases listed within the draft guideline that suggests that they will fall within the scope of the new connected digital health ecosystem being designed. Use cases listed include allowing patients to “integrate data from their health records into mobile apps and tools” and expanding the use of “at-home monitoring devices and electronic communications” to support population health efforts. With goals like this, there is no doubt that the intent of ONC is to provide consumer-facing technologies, like health apps and medication adherence apps, with access to the common clinical data set.


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