We’ve been talking about the importance of interoperability in health care for a while now—in articles like this one, this one, and this one. And while the idea of open, seamless data exchange among healthcare systems and providers always seemed like a great thing to have, it’s quickly becoming much more of a must-have. That’s because a collaborative-care, pay-for-performance healthcare model requires that providers from all disciplines actually communicate with one another in real-time to ensure they’re providing the very best care—at the very lowest cost—for their patients. Fax machines aren’t cutting it any longer. Rather, the only efficient way for providers to remain on the same page about a particular patient is to ensure that their documentation platforms seamlessly exchange accurate, complete, and comprehensive data.

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The 2017 ISA has been updated.

To that end, on December 20, 2016, the Office of the National Coordinator (ONC) for IT released its 2017 Interoperability Standards Advisory (ISA)—an update to the 2016 version. According to the ONC press release, the ISA is a collection of “essential standards and implementation specification for technology developer and clinicians to know.” Officially speaking, the ISA is designed to do—at least—the following:

  1. “Provide the industry with a single, public list of the standards and implementation specifications that can best be used to address specific clinical health information interoperability needs. Currently, the ISA is focused on interoperability for sharing information between entities and not on intra-organizational uses.  
  2. “Reflect the results of ongoing dialogue, debate, and consensus among industry stakeholders. When more than one standard or implementation specification could be used to address a specific interoperability need, discussion will take place through the ISA public comments process. The web-version of the ISA will improve upon existing processes, making comments more transparent, and allowing for threaded discussions to promote further dialogue.
  3. “Document known limitations, preconditions, and dependencies as well as provide suggestions for security best practices in the form of security patterns for referenced standards and implementation specifications when they are used to address a specific clinical health IT interoperability need.”

So, what’s new this year? Here are a few big changes in 2017:

  • The ONC has further transitioned the ISA from “a stand-alone document to a web-based resource with greater interactive features, additional opportunities for engagement with stakeholders, and...enhanced transparency to the process of updating the ISA.”
  • At the request of the Health IT Standards Committee, the ONC has discontinued its use of the term “best available” throughout the ISA.
  • The ISA now includes “more specific references to research and public health.”
  • There is a new section that begins to address functional and data models as well as function profiles.
  • Links will now enable viewers to jump to active projects listed in the ONC’s Interoperability Proving Ground.
  • “The pairing of standards for observation (i.e., questions) and standards for observation values (i.e., answers)” will be better represented.
  • Several of the informative characteristics are now more descriptive and/or revised.
  • The ONC will publish a static ISA reference edition each December; however the web-based ISA will reflect ongoing changes and updates throughout the year. (The ONC notes that provider “feedback and engagement is critical to improve and refine the ISA.”)

To learn more about the recent update to the ISA—and review the full document—click here.

According to National Coordinator Vindell Washington, MD, the 2017 ISA is “a key step toward achieving the goals we have outlined with our public and private sector partners in the Shared Nationwide Interoperability Roadmap, as well as the Interoperability Pledge announced earlier this year.”

There’s an Interoperability Pledge—and nearly every big EHR company has signed it.

So, what is this Interoperability Pledge? In February of 2016, at the Health Information and Management Systems Society (HIMSS) annual conference dubbed HIMSS16, Department of Health and Human Services Secretary Sylvia Burwell announced the Interoperability Pledge—at which time “companies that provide 90 percent of electronic health records used by hospitals nationwide as well as the top five largest private healthcare systems in the country...agreed to implement three core commitments,” namely:

  1. “To use standardized APIs,
  2. make it easier for patients to access their data, and
  3. not block information.”

While this may not sound like much at first glance, the American Health Information Management Association (AHIMA) “believes these three principles will make a significant and meaningful difference in making sure health information is available where and when it’s needed,” AHIMA CEO Lynne Thomas Gordon said.

Technology isn’t the only thing that will need to adapt for interoperability to be successful.

In this year-in-review post, Chilmark Research wrote that, “No doubt, connecting disparate systems in support of interoperability is a Herculean task. That being said, technology is not the main culprit behind the lack of interoperability today—it is cultural.” Washington said something similar in this Healthcare Dive interview: Information sharing, specifically as it relates to developing common standards, “is not a technology problem as much as it is a healthcare problem.” He then provided an anecdote from his own life to explain his point: when Washington was in training and wanted a blood test performed on a patient, he would call out the door of the exam room, “I need a chem 20.” But when he started practicing in another part of the country, he learned providers there didn’t say “chem 20”; some called these tests “panels,” others called them “complete blood cell counts,” and still others referred to them as “CBCs.” While aligning these “colloquial pieces” can be challenging, it’s crucial to ensuring seamless information exchange among providers who are not only located in different geographical locations, but also practicing in different specialties. That’s why Washington believes partnering with the specialty societies to work through these issues is imperative. That way, “when it is time to submit information or review information nationally, I can look across those different geographies and come up with a single definition,” he said.

There’s also the point that WebPT’s Charlotte Bohnett outlined in this post regarding the old adage: garbage in, garbage out. Specifically, Bohnett asked John Lynn’s question, “if ‘garbage data in produces garbage data out’ [then] do you really ‘want other people’s garbage in [your] system?’” I’d bet the answer is no. That means that as the interoperability ball gathers momentum, it is even more important for providers of all disciplines to up their data collecting—and reporting—games. Using incomplete, inaccurate, or intentionally falsified data will now have a negative system-wide impact.


Whether we get there in 2017, 2027, or somewhere in between, we’re moving into a fully interoperable healthcare environment. It’s coming—and it’ll be here before we know it. Does your clinic have the technology and data collection processes in place to transition gracefully? After all, as more bundled payment models come into play in this value-based payment paradigm, an increasing number of hospitals and healthcare organizations will be looking to partner with private practice rehab therapists to improve their patients’ outcomes—and only the PTs, OTs, and SLPs who use software that plays well with others will be able to participate.

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