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ONC’s Interoperability Standards Advisory Twitter Chat Summary

Posted on September 2, 2016 I Written By

The following is a guest blog post by Steve Sisko (@ShimCode and

Yesterday the Office of the National Coordinator for Health Information Technology (ONC) hosted an open chat to discuss their DRAFT 2017 Interoperability Standards Advisory (ISA) artifacts.  The chat was moderated by Steven Posnak, Director, Office of Standards and Technology at Office of the National Coordinator for Health Information and used the #ISAchat hashtag under the @HealthIT_Policy account. The @ONC_HealthIT Twitter account also weighed in.

It was encouraging to see that the ONC hosted a tweetchat to share information and solicit feedback and questions from interested parties. After a little bit of a rough start and clarification of the objectives of the chat, the pace of interactions increased and some good information and ideas were exchanged. In addition, some questions were raised; some of which were answered by Steven Posnak and some of which were not addressed.

What’s This All About?

This post summarizes all of the tweets from the #ISAchat. I’ve organized the tweets as best as I could and I’ve excluded re-tweets and most ‘salutatory’ and ‘thank you’ tweets.

Note: The @hitechanswers  account shared a partial summary of the #ISAchat on 8/31/16 but it included less than half of the tweets shared in this post. So you’re getting the complete scoop here.

Topic 1: Tell us about the ISA (Interoperability Standards Advisory)
Account Tweet Time
@gratefull080504 Question: What is the objective of #ISAchat?   12:04:35
@onc_healthit To spread the word and help people better understand what the ISA is about 12:05:00
@gratefull080504 Question: What are today’s objectives, please? 12:08:43
@onc_healthit Our objective is to educate interested parties. Answer questions & hear from the creators 12:11:02
@johnklimek “What’s this I hear about interoperability?” 12:12:00
@cperezmha What is #PPDX? What is #HIE? What is interoperability? What is interface? #providers need to know the differences. Most do not. 12:14:41
@techguy Who is the target audience for these documents? 12:44:06
@healthit_policy HITdevs, CIOs, start-ups, fed/state gov’t prog admins. Those that have a need to align standards 4 use #ISAchat 12:46:18
@ahier No one should have to use proprietary standards to connect to public data #ISAchat 12:46:19
@shimcode Reference Materials on ISA
Ok then, here’s the “2016 Interoperability Standards Advisory”
@shimcode And here’s “Draft 2017 Interoperability Standards Advisory” 12:07:38
@stephenkonya #ICYMI Here’s the link to the @ONC_HealthIT 2017 DRAFT Interoperability Standards Advisory (ISA): 12:10:57
@techguy Question: Do you have a good summary blog post that summarizes what’s available in the ISA? 12:52:15
@onc_healthit We do! Authored by @HealthIT_Policy and Chris Muir – both of whom are in the room for #ISAchat 12:53:15
@healthit_policy Good? – The ISA can help folks better understand what standards are being implemented & at what level 12:06:29
@healthit_policy Getting more detailed compared to prior versions due largely to HITSC & public comments 12:29:48
@healthit_policy More work this fall on our side to make that come to fruition. In future, we’re aiming for a “standards wikipedia” approach 12:33:03
@survivorshipit It would be particularly helpful to include cited full documents to facilitate patient, consumer participation 12:40:22
@davisjamie77 Seeing lots of references to plans to “explore inclusion” of certain data. Will progress updates be provided? 12:50:00
@healthit_policy 1/ Our next milestone will be release of final 2017 ISA in Dec. That will rep’snt full transition to web 12:51:15
@healthit_policy 2/ after that future ISA will be updated more regularly & hopefully with stakeholder involved curation 12:52:21
@bjrstn Topic:  How does the ISA link to the Interoperability Roadmap? 12:51:38
@cnsicorp How will #ISA impact Nationwide Interoperability Roadmap & already established priorities? 12:10:49
@healthit_policy ISA was 1st major deliverable concurrent w/ Roadmap. Will continue to b strong/underlying support to work 12:13:49
@healthit_policy ISA is 1 part of tech & policy section of Roadmap. Helps add transparency & provides common landscape 12:53:55
@healthit_policy Exciting thing for me is the initiated transition from PDF to a web-based/interactive experience w/ ISA 12:30:51
@onc_healthit Web-based version of the ISA can be found here: We welcome comments! 12:32:04
@techguy Little <HSML> From a Participant on the Ease of Consuming ISA Artifacts
So easy to consume!
@healthit_policy If I knew you better I’d sense some sarcasm :) that said, working on better nav approaches too 12:43:36
@techguy You know me well. It’s kind of like the challenge of EHRs. You can only make it so usable given the reqs. 12:45:36
@shimcode I think John forgot to enclose his tweet with <HSML> tags (Hyper Sarcasm Markup Language) 12:46:48
@ahier Don ‘t Use My Toothbrush!
OH (Overheard) at conference “Standards are like toothbrushes, everyone has one and no one wants to use yours”
Topic 2: What makes this ISA different than the previous drafts you have issued?
Account Tweet Time
@cnsicorp #Interoperability for rural communities priority 12:32:40
@healthit_policy Rural, underserved, LTPAC and other pieces of the interoperability puzzle all important #ISAchat 12:35:33
@cnsicorp “more efficient, closer to real-time updates and comments…, hyperlinks to projects…” 12:47:15
@shimcode Question: So you’re not providing any guidance on the implementation of interoperability standards? Hmm… 12:21:10
@gratefull080504 Question: Are implementation pilots planned? 12:22:51
@healthit_policy ISA reflects what’s out there, being used & worked on. Pointer to other resources, especially into future #ISAchat 12:24:10
@ahier The future is here it’s just not evenly distributed (yet) #ISAchat 12:25:15
@healthit_policy Yes, we put out 2 FOAs for High Impact Pilots & Standards Exploration Awards 12:25:56
@healthit_policy HHS Announces $1.5 Million in Funding Opportunities to Advance Common Health Data Standards. Info here:
Topic 3: If you had to pick one of your favorite parts of the ISA, what would it be?
Account Tweet Time
@shimcode The “Responses to Comments Requiring Additional Consideration” section. Helps me understand ONC’s thinking. 12:45:32
@healthit_policy Our aim is to help convey forward trajectory for ISA, as we shift to web, will be easier/efficient engagement 12:47:47
@healthit_policy Depends on sections. Some, like #FHIR, @LOINC, SNOMED-CT are pointed to a bunch. 12:49:15
@gratefull080504 Question: What can patients do to support the objectives of #ISAchat ? 12:07:02
@gratefull080504 Question: Isn’t #ISAChat for patients? Don’t set low expectations for patients 12:10:44
@gratefull080504 I am a patient + I suffer the consequences of lack of #interoperability 12:12:26
@healthit_policy Certainly want that perspective, would love thoughts on how to get more feedback from patients on ISA 12:12:35
@gratefull080504 What about patients? 12:13:03
@gratefull080504 First step is to ensure they have been invited. I am happy to help you after this chat 12:13:57
@survivorshipit Think partly to do w/cascade of knowledge–>as pts know more about tech, better able to advocate 12:15:21
@healthit_policy Open door, numerous oppty for comment, and representation on advisory committees. #MoreTheMerrier 12:15:52
@gratefull080504 I am currently on @ONC_HealthIT Consumer Advisory Task Force Happy to contribute further 12:17:08
@healthit_policy 1 / The ISA is technical in nature, & we haven’t gotten any comments on ISA before from patient groups 12:08:54
@healthit_policy 2/ but as we look to pt generated health data & other examples of bi-directional interop, we’d like to represent those uses in ISA 12:09:51
@resultant TYVM all! Trying to learn all i can about #interoperability & why we’re not making progress patients expect 13:09:22
@shimcode Question: Are use cases being developed in parallel with the Interoperability Standards? 12:13:28
@shimcode Value of standards don’t lie in level of adoption of std as a whole, but rather in implementation for a particular use case. 12:16:33
@healthit_policy We are trying to represent broader uses at this point in the “interoperability need” framing in ISA 12:18:58
@healthit_policy 2/ would be great into the future to have more detailed use case -> interop standards in the ISA with details 12:19:49
@healthit_policy Indeed, royal we will learn a lot from “doing” 12:20:40
@shimcode IHE Profiles provide a common language to discuss integration needs of healthcare sites and… Info here: 12:29:12
@techguy I’d love to see them take 1 section (say allergies) and translate where we’d see the standards in the wild. 12:59:04
@techguy Or some example use cases where people want to implement a standard and how to use ISA to guide it. 13:00:38
@healthit_policy Check out links now in ISA to the Interop Proving Ground – projects using #ISAchat standards. Info here: 13:02:54
@healthit_policy Thx for feedback, agree on need to translate from ISA to people seeing standards implemented in real life 13:01:08
@healthit_policy Commenting on ISA Artifacts
We want to make the #ISA more accessible, available, and update-able to be more current compared to 1x/yr publication
@cperezmha #interoperability lowers cost and shows better outcomes changing the culture of healthcare to be tech savvy is key 12:35:10
@healthit_policy One new feature we want to add to web ISA is citation ability to help document what’s happ’n with standards 12:37:12
@shimcode A “discussion forum” mechanism where individual aspects can be discussed & rated would be good. 12:39:53
@healthit_policy Good feedback. We’re looking at that kind of approach as an option. ISA will hopefully prompt debate 12:40:50
@shimcode Having to scroll through all those PDF’s and then open them 1 by 1 only to have to scroll some more is VERY inefficient. 12:41:25
@shimcode Well, I wouldn’t look/think too long about it. Adding that capability is ‘cheap’ & can make it way easier on all. 12:43:48
@shimcode Question: What Can Be Learned About Interoperability from the Private Sector?
Maybe @ONC_HealthIT can get input from Apple’s latest #healthIT purchase/Gliimpse? What do they know of interoperability?
@healthit_policy > interest from big tech cos and more mainstream awareness is good + more innovation Apple iOS has CCDA sprt 12:22:59
@drewivan Testing & Tools
I haven’t had time to count, but does anyone know approximately how many different standards are included in the document?
@healthit_policy Don’t know stat off had, but we do identify and provide links for test tools as available. 12:56:31
@drewivan And what percentage of them have test tools available? 12:54:38
@shimcode According to the 2017 ISA stds just released, a tiny fraction of them have test tools. See here: 12:58:02
@shimcode I take back “tiny faction” comment on test tools. I count 92 don’t have test tools, 46 do. No assessment of tool quality though. 13:08:31
@healthit_policy Testing def an area for pub-private improvement, would love to see # increase, with freely available too 12:59:10
@techguy A topic near and dear to @interopguy’s heart! 12:59:54
@resultant Perhaps we could replace a couple days of HIMSS one year with #interoperability testing? #OutsideBox 13:02:30
Walk on Topic: Promotion of ISA (Thank you @cperezmha)
What can HIE clinics do to help other non-users get on board? Is there a certain resource we should point them too to implement?
Account Tweet Time
@davisjamie77 Liking the idea of an interactive resource library. How will you promote it to grow use? 12:35:57
@healthit_policy A tweetchat of course! ;) Also web ISA now linking to projects in the Interoperability Proving Ground 12:39:04
@davisjamie77 Lol! Of course! Just seeing if RECs, HIEs, other #HIT programs might help promote. 12:40:44
@healthit_policy Exactly… opportunities to use existing relationships and comm channels ONC has to spread the word 12:41:28
@stephenkonya Question: How can we better align public vs private #healthcare delivery systems through #interoperability standards? 12:42:23
Miscellaneous Feedback from Participants
Account Tweet Time
@ahier Restful APIs & using JSON and other modern technologies 12:54:03
@waynekubick Wayne Kubick joining from #HL7 anxious to hear how #FHIR and #CCDA can help further advance #interoperability. 12:11:30
@resultant We all do! The great fail of #MU was that we spent $38B and did not get #interoperability 12:14:21
@waynekubick SMART on #FHIR can help patients access and gain insights from their own health data — and share it with care providers. 12:17:44
@resultant I think throwing money at it is the only solution… IMHO providers are not going to move to do it on their own… 12:20:44
@shimcode @Search_E_O your automatic RT’s of the #ISAChat tweets are just clouding up the stream. Why? smh 12:08:30
Do you see #blockchain making it into future ISA
@healthit_policy Phew… toughy. lots of potential directions for it. Going to segue my response into T2 12:28:58
@hitpol #blockchain for healthcare! ➡ @ONC_HealthIT blockchain challenge. Info here: 12:31:33
@healthit_policy That’s All Folks!
Thank you everyone for joining our #ISAchat! Don’t forget to leave comments.
PDF version

About Steve Sisko
Steve Sisko has over 20 years of experience in the healthcare industry and is a consultant focused on healthcare data, technology and services – mainly for health plans, payers and risk-bearing providers. Steve is known as @ShimCode on Twitter and runs a blog at You can learn more about Steve at his LinkedIn page and he can be contacted at

Healthcare Data Standards Tweetstorm from Arien Malec

Posted on May 20, 2016 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you don’t follow Arien Malec on Twitter, you should. He’s got strong opinions and an inside perspective on the real challenges associated with healthcare data interoperability.

As proof, check out the following Healthcare Standards tweetstorm he posted (removed from the tweet for easy reading):

1/ Reminder: #MU & CEHRT include standards for terminology, content, security & transport. Covers eRx, lab, Transitions of Care.

2/ If you think we “don’t have interop” b/c no standards name, wrong.

3/ Standards could be ineffective, may be wrong, may not be implemented in practice, or other elts. missing

4/ But these are *different* problems from “gov’t didn’t name standards” & fixes are different too.

5/ e.g., “providers don’t want 60p CCDA documents” – data should be structured & incorporated.

6/ #actually both (structured data w/terminology & incorporate) are required by MU/certification.

7/ “but they don’t work” — OK, why? & what’s the fix?

8/ “Government should have invested in making the standards better”

9/ #actually did. NLM invested in terminology. @ONC_HealthIT invested in CCDA & LRU projects w/ @HL7, etc.

10/ “government shouldn’t have named standards unless they were known to work” — would have led to 0 named

11/ None of this is to say we don’t have silos, impediments to #interoperability, etc.

12/ but you can’t fix the problem unless you understand it first.

13/ & “gov’t didn’t name standards” isn’t the problem.

14/ So describe the problems, let’s work on fixing them, & abandon magical thinking & 🦄. The End.

Here was my immediate response to the tweetstorm:

I agree with much of what Arien says about their being standards and the government named the standards. That isn’t the reason that exchange of health information isn’t happening. As he says in his 3rd tweet above, the standards might not be effective, they may be implemented poorly, the standards might be missing elements, etc etc etc. However, you can’t say there wasn’t a standard and that the government didn’t choose a standard.

Can we just all be honest with ourselves and admit that many people in healthcare don’t want health data to be shared? If they did, we’d have solved this problem.

The good news is that there are some signs that this is changing. However, changing someone from not wanting to share data is a hard thing and usually happens in steps. You don’t just over night have a company or individual change their culture to one of open data sharing.

Healthcare Standard Proliferation Comic

Posted on July 24, 2015 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It’s Friday and I’m in Utah where today is a state holiday (think a second July 4th party). What does all that mean? It’s time for another Fun Friday post. I thought this comic that Dan Munro shared would be perfect:

I think the only modification we need is to have it say “See: Healthcare.” If you want to make this educational, the comic does point out some other places we could look to see where standard proliferation has been a problem. Or you could just enjoy the humor and head for the weekend. Either way, Happy Friday!

More Honest Perspective on Meaningful Use Stage 2

Posted on January 8, 2014 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There’s been a really strong reaction to this post on One EHR Vendor’s Experience with MU Stage 2 certification. Although, Gabriel Perna pointed out that there was a lot of “I dislike” in the article and not enough like. Of course, part of that was because it wasn’t intended as a journalistic effort to cover both angles, but was a private response turned public. However, I was intrigued by the question of what Michael Archuleta, Founder and CEO of ArcSys, might “like” about meaningful use.

Here’s Michael’s response:

I REALLY like Context Aware Information.

I do like the idea that doctors have to be more timely on providing completed documentation.

I do like the notion that meeting MU provides a sense of continuity and expectations between doctors with different systems.

I do like the fact that documentation standards need to be lived up to within a practice.

I do like the fact that MU has already helped alert real patients to real problems.

I do like the fact that MU provides additional tools to help the doctor provide more information to their patients.

Wish my list were longer.

I recognize my “dislike” list comes across as a lot of whining. But, if there is no leadership or anyone willing to respond to my concerns, then the EMR community will struggle.

Plus, Michael added some more perspective to his previous comments:

Part of the frustration is that I spent 20 years of my life dealing with inconsistencies of the “standards” associated with electronic claims. Each insurance carrier would read the same rules differently and we, the vendors, had to code for zillions of contingencies.

Then the same thing happens with HL7 lab results.

Then we get MU and a whole set of “standards” and “rules”. It sounds like the same old song but on a different radio station.

What are we going to do when the SNOMED advocates feel their codes should trump Rxnorm or LOINC or ICD-10? When I talk with doctors about their understanding of these various coding systems, they are mostly clueless. If they balk at implementing ICD-10, wait until they meet SNOMED. Has anyone laid out the rules with respect to certification of when to use atomic-ids rather than concept-ids? These are but a few of the unknowns that people will encounter.

If I could have implemented and coded all the rules for MU2 before the final rules were published, then I could have asked real questions. But, there was no time, so now I live with the consequences. It is akin to the famous Pelosi statement, “You have to pass the law in order to know what’s in it.”

There is definitely a challenge in the rule making process. I really think that ONC takes the public comments very seriously. The challenging question is whether the right people are making the comments and whether the comments are informed or not.

Full CCHIT Certification Estimates

Posted on September 16, 2010 I Written By

John Lynn is the Founder of the blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of and John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve written previously about the cost of EHR certification with Drummond Group and CCHIT. However, this just addresses the hard cost of certification that’s paid to the certifying bodies. This cost doesn’t take into account a lot of other costs associated with becoming a certified EHR like the cost to develop and test the features that certification requires.

Keith Boone on his blog Healthcare Standards has done a great blog post that evaluates the other costs associated with certifying an EHR software beyond the fee you pay to the certifying body. If you’re an EMR vendor, this is an article that you definitely want to look at and consider. Plus, I’d love your feedback on things he missed or where he might have missed costs or estimated to high on costs.

Here’s Keith’s projections for EHR certification costs based on his estimates:
Average yearly developer salary: $80,000
Fully Burdened yearly cost: 200,000 – 240,000
Times the length of the project (~5.5 years)
Total certification labor cost: $1.1M – $1.32M

Of course, this number matches the estimates that came out with the HITECH act as well. ONC estimated between $500k-$1.5 million. So, this is pretty close.

I’ll leave the impact (good or bad) of this expense open for discussion. I think most people know where I stand on it.