After receiving concerns from stakeholders, EHR technology developers and ONC-ATCBs about public health surveillance specifications for certified EHRs, the ONC issued an interim final rule requesting to remove the specs.
The interim final rule was published and made effective in the Federal Register on Oct. 13. Comments on the rule will be accepted until Nov. 12 at 5 p.m.
According to the notice in the Federal Register, in the Standards and Certification Criteria Final Rule, two content exchange standards were adopted for electronic submission to public health agencies for surveillance and reporting, Health Level Seven (HL7) versions 2.3.1 and 2.5.1. In response to public comments, the ONC also implemented specifications for HL7 2.5.1: Public Health Information Network HL7 Version 2.5 Message Structure Specification for National Condition Reporting Final Version 1.0 and the Errata and Clarifications National Notification Message Structural Specification. The ONC did not adopt at that time implementation specifications for HL7 2.3.1.
In the Federal Register, the ONC gave its reasoning behind its revisions to remove the implementation specs related to public health surveillance: "Some stakeholder representatives indicated that they thought these implementation specifications may have been adopted in error. They noted that these implementation specifications do not appear to be appropriate for implementing the adopted standard, HL7 2.5.1 for public health surveillance (syndromic surveillance) purposes … we have determined that these implementation specifications were adopted in error. "
The adopted implementation specifications provide direction to public health agencies on the structure and methodology for using HL7 2.5.1 to report 'Nationally Notifiable Conditions'' to CDC and do not provide additional clarity for how EHR technology would need to be designed to implement the adopted standard (HL7 2.5.1) or enable compliance with the capability identified in the certification criterion adopted.
"Therefore, their adoption neither provides the appropriate or requisite implementation capability for the adopted standard, HL7 2.5.1, nor, more importantly, would enable the user to 'electronically record, modify, retrieve, and submit syndrome-based public health surveillance information as required by the adopted certification criterion.'
"We have also heard from ONC–ATCBs as well as EHR technology developers that the erroneous adoption of these implementation specifications creates significant ambiguity and concern regarding whether these implementation specifications must be used for testing and certification," said the ONC.
