In addition to highlighting progress made on several fronts by the Office of the National Coordinator for Health IT, the annual report of its Health Information Technology Advisory Committee (HITAC) also identified interoperability and data standard gaps and specific actions HITAC could take to address them.
The 2023 annual report identified several target areas, including health equity, public health, interoperability, privacy and security, and patient access to information. It then gave examples of activities the federal government has taken to address them, including TEFCA, USCDI, and continued implementation of the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program Final Rule. In January 2024, ONC published its HTI-1 final rule to implement provisions of the Cures Act and make updates to the ONC Health IT Certification Program with new and updated standards, implementation specifications, and certification criteria.
The report mentions several areas that still need ONC attention. The following is a partial description of the topics it identified.
With regard to artificial intelligence and algorithmic bias and transparency, recommended HITAC activities include working in collaboration with relevant HHS agencies to support the development of guidance to assist providers, certified health IT developers, and other health IT developers with the implementation of the HTI-1 final rule’s algorithm bias policies, including their evaluation of “fair, appropriate, valid, effective, and safe”(FAVES) and the implications for specific patient populations.
The report notes that there is a lack of infrastructure to support the connectivity of pharmacy data with the broader health IT ecosystem. The report recommends exploring requirements for reference laboratories to adopt USCDI data classes and elements, and helping pharmacies leverage TEFCA for treatment purposes. In terms of improving interoperability with pharmacies and laboratories, the report recommends exploring what steps the Centers for Medicare & Medicaid Services (CMS) may be taking to incentivize or require laboratory and pharmacy interoperability.
Providing better interoperability with long-term and post-acute care providers is another goal. The report said the ONC could explore incentives or requirements for LTPAC providers to meet the standards for the Medicare Promoting Interoperability Programs standards. It could also explore what actions HHS can take to advance LTPAC interoperability including reviewing steps CMS may be taking to incentivize sharing of LTPAC data and exploring certification needs for LTPAC providers’ health IT systems to support bi-directional exchange with acute and ambulatory providers that have already adopted certified Health IT Modules.
In the realm of privacy of sensitive health data, the report says ONC should look at implementing enabling infrastructure to support the interoperable exchange of consent directives. It should also evaluate the current models and suggest steps toward a terminology value set for sensitive health data elements that could be widely adopted and enable the exchange of computable consent decisions.
Noting that today patients have limited transparency into how their identified and de-identified health data are shared, the report said ONC should explore the metadata needed to implement prioritized use cases that allow patients and healthcare organizations to understand who is accessing patient data and for what purpose.
Further, it could explore supporting a pilot of the prioritized use cases to ensure the data shared with patients is meaningful and balances information value with information overload.
Concerning Patient-Generated Health Data (PGHD), there could be work to improve standards and metadata to support the incorporation and personal access and control of clinically relevant PGHD collected from health apps, wearable devices (both consumer and medical), and other sources.
