ONC Efforts Driving Interoperability

Building a strong foundation of health IT is critical to realizing the goal that care is delivered to every American using an electronic health record (EHR). To achieve this goal, the tools, the technologies, and the resources must exist so that every person has access to a long-term, comprehensive digital picture of their health over their lifespan.

With that in mind, The Office of the National Coordinator for Health Information Technology (ONC) has put forward a number of resources to provide the vision, guidance, and metrics to ensure that the right care is delivered at the right place and time to patients all the time. The following includes information on specific ONC efforts to assist implementers and influencers on their journey toward achieving interoperability, and related HIMSS resources and comments about these efforts.


The Interoperability Standards Advisory (ISA) process represents a single, public list of standards and implementation specifications published by Office of the National Coordinator for Health Information Technology (ONC). ONC coordinates the identification, assessment and determination of these recommended interoperability standards and implementation specifications for industry use to fulfill specific clinical health IT interoperability needs. Stakeholders are encouraged to implement and use these recommended standards as applicable to their interoperability needs.

The ISA is organized and structured into five sections with related interoperability needs. Each interoperability need includes one or more standards or implementation specifications to accomplish the listed need. Additional characteristics on these standards and implementation specifications are listed to inform stakeholders on maturity and adoption. These include:

  1. Standards Process Maturity: Conveys maturity in terms of its stage within a particular organization’s approval/voting process.
  2. Implementation Maturity: Conveys maturity based upon its implementation state.
  3. Adoption Level: Approximate, average adoption level for that specific interoperability need in health care within the United States.
  4. Federally Required Status: Conveys whether a standard or implementation specification has been adopted in regulation, referenced as a federal program requirement, or referenced in a federal procurement (i.e., contract or grant) for a particular interoperability need.
  5. Cost: Conveys whether a fee is involved to purchase, license, or obtain membership for access or use of the recommended standard or implementation specification.
  6. Test Tool Availability: Conveys whether a test tool is available to evaluate health IT’s conformance to the standard or implementation specification for the particular interoperability need.

HIMSS Standards Advisory Task Force

The HIMSS Standards Advisory Task Force conducts ongoing review of the ISA and regularly submits comments to ONC on how to improve on the information included in the web-based resource. See below for previous HIMSS comments created by this volunteer group.

HIMSS Responses to 2018 Interoperability Standards Advisory

May 2018 Response to New Interoperability Needs in 2018 Edition


HIMSS Ongoing Responses to 2017 Interoperability Standards Advisory

November 2017 Response to ONC Additional Request for Feedback September 2017 Responses to Section I and Appendix I Requests for Feedback

June 2017 Responses to Sections II and III Requests for Feedback

April 2017 Responses to General Questions and Section I Requests for Feedback


Previous Comments

HIMSS Response to the Draft 2017 Interoperability Standards Advisory

HIMSS Response to the 2016 Interoperability Standards Advisory

HIMSS Response to the Draft 2016 Interoperability Standards Advisory

HIMSS Response to the 2015 Interoperability Standards Advisory

The recently proposed ONC Interoperability Standards Measurement Framework (the Framework) aims to measure the nation’s status on the implementation and use of interoperability standards to better understand progress toward nationwide interoperability. The Framework will also use these measures to help identify barriers to implementation and use.

ONC has identified two main objectives for the Framework:

  1. Understand if specific standards are built into health IT products and available to end users (i.e., the implementation lifecycle)
  2. Understand the use of standards and how they are deployed into production systems to meet specific interoperability needs as well as the level of conformance or customization of standards during implementation

This Framework has the potential to benefit the health IT industry in three ways:

  1. To inform the evolution of the Interoperability Standards Advisory (ISA)
  2. To inform updates to the ONC Health IT Certification Program
  3. To inform stakeholder decision-making

Click here to view the HIMSS Response to the ONC Proposed Framework


The Shared Nationwide Interoperability Roadmap lays out a plan in three, six and ten year increments to achieve the interoperability needed to enable a learning health system. This plan builds on standards that enable the foundation for interoperability today, and processes to test and certify that health IT systems implement those standards consistently and according to constrained implementation guidance.

This Roadmap was a product of ONC’s 10-Year Vision to Achieve an Interoperable Health IT Infrastructure (aka ONC’s 10-Year Interoperability Concept Paper). This paper defined a set of guiding principles and building blocks to drive interoperability.


  • Build upon existing health infrastructure where possible.
  • One size does not fit all for approaches to achieve interoperability with systems.
  • Empower individuals to become more active participants and partners in their health and care.
  • Leverage the market to encourage innovation to meeting evolving demands for interoperability.
  • Simplify solutions where possible.
  • Maintain modularity to allow system capabilities to evolve with innovation.
  • Consider the current environment for health IT and support multiple levels of advancement.
  • Focus on value such as improved health and lower costs that result from interoperability efforts.
  • Protect privacy and security in all aspects of interoperability.
  • Standards and interoperability efforts must be accessible nationwide and scalable to varying implementation needs.

View the HIMSS Interoperability Roadmaps and Summary Matrix to see how ONC’s Roadmap compares with others presented in the health IT community.

Health IT, Health Information Exchange, interoperability, ONC