The American Medical Informatics Association (AMIA) responded to a request for information (RFI) issued by the Office of the National Coordinator for Health IT (ONC) outlining a draft framework to measure the use of interoperability standards in health IT products. The national association of health informatics professionals supported ONC’s draft framework, recommending a measurement approach that focuses on the clinician and patient experience. AMIA underscored the need to have the benefits of any measurement outweigh the costs, and urged federal officials to provide sufficient support to develop and implement automated measurement solutions.
The Framework
ONC issued its “Proposed Interoperability Standards Measurement Framework” in April, seeking feedback on an industry-wide measurement framework for assessing the implementation and use of healthcare interoperability standards. Currently, stakeholders’ capabilities to measure and report on the use of standards vary significantly across the health IT ecosystem, ONC noted. This framework is meant to help health IT developers, health information exchange organizations, and healthcare providers move towards a set of uniform measures to assess interoperability progress.
The purpose of the Framework is to determine the nation’s progress in implementing interoperability standards in health information technology (health IT) and the use of the standards as a way to measure progress towards nationwide interoperability. The Framework will also help identify specific barriers to implementation that need to be addressed.
Key measurement areas that ONC has identified include: (1) tracking whether interoperability standards are contained in health IT products and services and (2) the subsequent use of standards by end users (e.g., providers), including whether end users are customizing their use of the standards.
AMIA Comments
AMIA recommended that measurement and measure reporting: (1) be automated wherever possible; (2) initially, target high-value standards/use cases; and (3) deliver value to those stakeholders being measured.
AMIA supported the proposed measures outlined in Objective 1, saying, “We anticipate that individual developers and the wider industry would benefit from data obtained from reporting on Objective 1 Measurement Areas, and we anticipate that reporting on those measures would place minimal burdens on health IT developers and exchange networks.” However, AMIA said Objective 2 “will require substantial examination, broad stakeholder input, and – potentially – much work to realize a positive benefit/burden ratio.”
“AMIA recommends ONC develop both quantitative and qualitative measures for Objective 2 Measurement Areas,” the organization said in comments. “As an initial step, ONC must understand which standards are used to facilitate interoperability for clinical use cases that are widely considered to have high-value for patients. Focusing on high-value use cases and associated standards will constrain the measurement options and limit the reporting burden.”
Supporting Statements
“We need federal officials to think differently about how to measure interoperability,” said AMIA Board Chair and Medical Director of IT Services at the University of Washington’s UW Medicine, Thomas H. Payne, MD. “The issue of ‘Do we have interoperability?’ is a complex and dynamic question, but a vitally important one. We must dig into the details and answer that question from both a clinician’s and a patient’s perspective.”
“Interoperability is hard in the concrete and impossible in the abstract,” said AMIA President and CEO Douglas H. Fridsma, MD, PhD, FACP, FACMI. “We will make the best progress toward measuring interoperability when we can clearly define what we want to do with the information that is exchanged. Focusing on specific ways in which we can support clinicians and improve the health and healthcare of patients is the best hope we have to make substantive and measurable progress towards widespread interoperability.”