The Standard

By the US Realm Co-Chairs: Brett Marquard, Steve Posnack and Dan Vreeman, DPT

Greetings HL7 community, your US Realm Steering Committee co-chairs come bearing news. For the past few years, we have started to do a “state of the realm” recap for everyone at the January WGM. The full details are available here, but we wanted to celebrate and acknowledge some of 2023’s great work and what’s to come in 2024 through this post as well.

2023

• US Core 6.1.0 and C-CDA Companion Guide R4.1 were published to add USCDI version 3 guidance.
• CDA Web and C-CDA Web were balloted in a common HL7 publication framework.
• US Public Health Library 1.0.0 was published, which represents a domain specific profile library in the US Realm and a foundation for future public health projects.

2024

• US Core will finalize USCDI v4 in May 2024, and then begin v5 design (in the fall).
• C-CDA web publishing, using the FHIR StructureDefinition to support USCDI v4 (now) and then v5 (in the fall).
• Now that ONC’s HTI-1 Final Rule is out and concrete dates are set, the industry transition from US Core 3.1.1 as a baseline to 6.1.0 is upon us. US Realm, in collaboration with other work groups, will be prioritizing its time to focus on supporting this migration. Please engage early and often this year as transition issues pop-up for you.

Hear about the ONC’s USCDI+ Quality Initiative and learn the latest about the Quality Measures for Cancer Use Case on July 28

The Centers for Medicare & Medicaid Services (CMS) released the much-awaited Interoperability & Patient Access Rule in early March this year. This rule establishes policies that aim to break down barriers in the health system across the US for better patient engagement. Government bodies are taking significant efforts for governments-sponsored health plans to adopt interoperability to make healthcare system efficient. Multiple initiatives by the Department of Health and Human Services (HHS) and its CMS and Office of the National Coordinator for Health Information Technology (ONC) aim to improve care-coordination and member experience. CMS had proposed the Interoperability & Patient Access Rule to support regulations of the MyHealthEData initiative, with implementation timelines to drive programs such as BlueButton, BlueButton 2.0 and Data at the Point of Care.

In the times of pandemic, healthcare organizations have realized the importance of having access to data for better care coordination and efficient care delivery. With seamless data access, organizations can:

• Share health data of beneficiaries with different care teams
• Identify high-risk population and implement preventive actions to control risk
• Leverage tele-health with access to patient historical health data
• Take timely decisions on emergency treatments based on patient medication history

Limitations in existing healthcare interoperability present a significant barrier to next-gen computing solutions such as Machine Learning (ML) and Artificial Intelligence (AI). New workflow standards aimed at addressing the integration of AI/ML actors to clinicians in delivering better patient care.

One of the main limitations of standards is streamlining access to data from electronic medical record (EMR) applications. There is a growing need for a holistic view of patient data, and the inclusion of the allied healthcare services such as radiology will play a crucial role in building a 360° patient view. This will help healthcare professionals take accurate and informed decision on patient care, and bridge the gap between fragmented and siloed information that is currently limiting hospitals and healthcare systems from gaining insights to drive better health outcomes.

To seek better exchange of health data among providers and patients, the Health and Human Services (HHS) published final rules that put patients first and bring one step closer to achieving Interoperability. The ONC’s (Office of the National Coordinator for Health Information Technology) rule aims to standardize API via HL7 Fast Healthcare Interoperability Resources (FHIR®) R4, a latest version of the FHIR standard, and making its use mandatory under this rule.