ONC adds seven interoperability needs

The Assistant Secretary for Technology Policy/Office of the National Coordinator released the 2026 Interoperability Standards Advisory Reference Edition on April 7, updating the federal catalog of standards and implementation specifications used across healthcare data exchange. (ecqi.healthit.gov) The agency said the 2026 edition incorporates the Federal FHIR Action Plan, a government framework first released in 2024 to guide federal investment in and adoption of the HL7 FHIR standard. The ISA is a reference document rather than a regulation, but ASTP says it is meant to coordinate how the industry addresses specific interoperability needs across clinical, public health, research and administrative uses. (isp.healthit.gov 1) (isp.healthit.gov 2) The 2026 update also adds new interoperability need pages and appendices, according to ASTP’s recent-updates page. Those additions include pages for representing patient family genomic history, representing personal genomic history, allowing pharmacy benefit payers to communicate real-time prescription benefit information to prescriber systems, and real-world data retrieval for clinical research. ASTP also added Appendix V for the Federal FHIR Action Plan and Appendix VI for AI for Interoperability. ### Which part of the ISA changed this year? ASTP’s recent-updates page says the 2026 ISA Reference Edition incorporated the Federal FHIR Action Plan and marked standards and implementation specifications aligned with that plan on relevant interoperability-need pages. (ecqi.healthit.gov) The same page lists renamed pages in nutrition, occupation, public health emergency surveillance, social care procedures and family health history, alongside the newly added pages. The eCQI Resource Center, which republishes ISA updates, said on April 7 that the 2026 edition “incorporates the Federal FHIR Action Plan.” It said the plan is intended to inform federal investment in and adoption of FHIR and will continue to evolve as agencies make new investments and the industry changes. (isp.healthit.gov) ### What does the ISA actually do for vendors and providers? The ISA process is the model by which ASTP/ONC identifies, assesses and publicizes “recognized” interoperability standards and implementation specifications for specific healthcare data-exchange needs, according to the agency’s introduction and overview pages. ASTP says it encourages stakeholders to use the listed standards where applicable and to pilot standards labeled “emerging.” (isp.healthit.gov) ASTP’s overview also says the ISA is not limited to electronic health record systems. The scope includes health IT used for treatment, referrals, public health reporting, research and administrative functions, and the agency says administrative interoperability needs have been added in coordination with the Centers for Medicare and Medicaid Services. (ecqi.healthit.gov) ### Where do referrals and provenance show up in the current ISA? The ISA page for “Referral to a Specialist - Request, Status Updates, Outcome” lists C-CDA implementation guides as production options and identifies IHE’s 360 Exchange - Closed Loop Referral, or 360X, as an emerging implementation specification. The page says feedback is requested on that emerging referral standard. (isp.healthit.gov) The ISA page for “Representing Data Provenance” lists the HL7 FHIR Provenance Resource as an implementation specification with feedback requested status. That page also identifies data elements including author time stamp and author organization, which are used to show when information was recorded and which organization was associated with the author at the time of interaction with the data. (isp.healthit.gov) ### How are demographics and front-office data exchange part of this? The United States Core Data for Interoperability, which ASTP requires in parts of the Health IT Certification Program, is the agency’s standardized set of health data classes and elements for nationwide exchange. ASTP says USCDI is meant to support interoperable exchange of core patient information, and the platform includes patient demographics and provenance as data classes under that broader framework. (isp.healthit.gov) The ISA itself does not direct vendors to build front-office automation tools. But ASTP says the advisory is designed for all types of health IT, not only EHRs, and includes administrative functions and referral workflows. That means vendors that handle intake, referral management, scheduling or document exchange can use the same federal reference set when deciding which standards to support. (isp.healthit.gov) That is an inference from the scope ASTP describes, not a statement the agency makes in those terms. ### When can stakeholders push for more changes? ASTP’s timeline page says comments on the ISA are accepted year-round and that the web version can be updated throughout the year as the standards environment changes. (healthit.gov) The agency says a formal annual review-and-comment period opens for 60 days in late summer or early fall, after which staff review comments and prepare the next reference edition for publication by early January. (isp.healthit.gov) (isp.healthit.gov)