Certified Health IT Adoption a Step Toward Broad Interoperability

While ONC 2015 certified health IT adoption has improved data exchange across the care continuum, the program’s ability to achieve nationwide interoperability is limited, according to an ONC study published in JAMIA.

Almost all hospitals and 80 percent of physicians have implemented EHRs certified through the ONC Health IT Certification Program.

The 2015 Edition Health IT Certification Criteria updated several key standards requirements, such as the Consolidated-Clinical Document Architecture (C-CDA) and Applicability Statement for Secure Health Transport standards.

The researchers found that almost 40 percent of hospitals adopted the 2015 Edition certified health IT between 2016 and 2018, which increased interoperability engagement by 18 percent.

Between 2014 and 2018, hospital interoperability rates doubled from 23 percent to 46 percent. ONC researchers found that the adoption of 2015 Edition certified health IT was responsible for 11 percent of that interoperability increase.

Notably, hospitals that switched to different EHR vendors had higher interoperability gains from adopting the 2015 Edition technology than those that kept the same vendor.

However, despite the increase in data exchange capabilities due to 2015 Edition certified health IT adoption, the study highlighted that adoption alone will not lead to nationwide interoperability.

The study authors forecasted how interoperability rates would change depending on how many hospitals had adopted 2015 Edition certified health IT. They found that even if all hospitals had adopted the 2015 certified health IT, between 53 percent and 61 percent of hospitals would routinely engage in interoperable health information exchange.

“While updates to the ONC Health IT Certification Program, in the form of revisions to certified technology technical specifications and data standards, can help accelerate improvements in interoperability, they are unlikely to deliver on nationwide interoperability alone,” the study authors wrote. “The 2015 Edition has a clear upper bound on its ability to advance interoperability.”

Additional ONC data from February 2021 supported this prediction; while 90 percent of hospitals had adopted 2015 Edition certified health IT by the end of 2019, only 55 percent of hospitals were able to electronically send, receive, locate, and integrate patient health records from sources outside of their care organization on a routine basis.

The authors of the most recent ONC study, Talisha Searcy, Yuriy Pylypchuk, Wes Barker, and William Encinosa outlined several ways that the agency is building on interoperability gains from 2015 edition certified health IT adoption to push towards true nationwide interoperability in an ONC HealthITBuzz blog post.

The authors noted that ONC has introduced several new standards and regulations to promote interoperability, such as the 2020 ONC Cures Act Final Rule which established the basic health data that certified health IT vendors must support in their development of digital health solutions, as well as the way this data must be available to patients and providers.

Additionally, United States Core Data for Interoperability (USCDI) is a new “standard of standards” that outlines a set of health data classes and data elements for nationwide health information exchange, the authors noted.

“In addition to identifying the USCDI, ONC also established a new Certification Criterion to make the data included as part of the USCDI available via secure, standardized application programming interfaces (API) for patient and population services,” the study authors wrote.

“Together, these new aspects of the 2015 Edition will support an ecosystem of applications, improve interoperability, and position patients, clinicians, and researchers to manage health data in more modern ways,” they continued.