The ONC received 74 comments with almost 400 recommended changes to the ISA in the past three months.
The revised advisory includes additional "interoperability needs" the industry must address in order to increase information-sharing, such as standards for electronic prescribing that would let prescribers send controlled-substance prescriptions to pharmacies and allow pharmacies to request additional refills from prescribers.
The advisory isn't binding, but the ONC asks stakeholders to use it and to test "emerging" standards and specifications. These include the medication reference terminology, a standard for listing medication allergies, and FHIR, a framework for moving health data, which is considered an emerging standard for several interoperability needs.
Health Level Seven, which oversees FHIR, just published a new version of the standard. The new version includes stable versions of several FHIR elements. That means that if developers create a tool based on those elements today, the tool will still work after the next version of FHIR is released.
FHIR is perhaps the most well-promoted emerging standard. According to the ONC, the standard has hit a tipping point and is finally catching on. Most hospitals and MIPS-eligible clinicians who use federally certified products have software from developers that support FHIR in at least some of their products, according to the ONC. Vendor adoption still remains low, with uptake by just 32% of vendors certified to the "application access–data category request" requirement.
But the organizations that have taken on FHIR projects are notable. The CMS is using the standard for its Blue Button 2.0, an initiative that lets beneficiaries pull their claims data into third-party apps. And Apple uses FHIR to allow iPhone users to download their health record data in the iOS Health app.
The ONC will continue to update the ISA as feedback comes in from stakeholders, the Health IT Advisory Committee and others. To make updates easy to track, the agency has created an RSS feed of changes. The 2019 Reference Edition of the ISA, also released Monday, provides a static view.
