ONC Seeks Input on Diagnostic Image Exchange Standards
The Office of the National Coordinator for Health IT (ONC) is seeking public comment on standards for the exchange of diagnostic images through certified health IT. The initiative aims to improve interoperability for medical imaging, a key component of patient records. This effort aligns with broader industry discussions on integrating imaging systems with EHRs using modern standards like HL7 FHIR and DICOM.
- The ONC's request for information, open for public comment until March 16, 2026, seeks input on adopting technical standards to resolve persistent challenges in image exchange, such as reliance on CDs, inconsistent metadata, and limited API support. This initiative is part of a broader effort that includes the Draft United States Core Data for Interoperability Version 7 (USCDI v7). - Current systems for storing medical images, like Picture Archiving and Communication Systems (PACS), are often separate from the main Electronic Health Record (EHR), creating data silos. This fragmentation can lead to workflow inefficiencies, delayed or missed diagnoses, and duplicate testing because clinicians lack a comprehensive patient view. - The FHIR standard enables EHRs and other health IT systems to exchange clinical data via RESTful APIs, but it does not store the images themselves. Instead, a FHIR resource called 'ImagingStudy' acts as a bridge, containing metadata and a link that allows for the retrieval of images from a PACS or Vendor Neutral Archive (VNA) using DICOMweb protocols. - Epic's interoperability platform, Care Everywhere, utilizes FHIR APIs to facilitate the exchange of clinical data, including notifications about recent or similar imaging orders to prevent duplication. One analysis by Epic showed this feature helped avert over 5.8 million duplicative imaging exams in one year, saving an estimated $310 million to $2.6 billion. - From a clinical end-user perspective, a common frustration for ICU nurses is the excessive time spent on documentation and navigating non-intuitive EHR interfaces, which detracts from direct patient care. A survey by KLAS found that nearly one-third of nurses experiencing burnout cited their EHR as a contributor, with 65% feeling they have no voice in EHR changes. - For ICU nurses transitioning to informatics, employers often seek experience with EHR implementation and optimization, data analysis skills, and an understanding of clinical workflows. Certifications like the American Nurses Credentialing Center (ANCC) Informatics Nursing Certification (NI-BC) can validate expertise and are often preferred for informatics roles. - Many nurses report that EHRs are designed with a physician-centric workflow, leading to "click fatigue" and redundant data entry for nursing staff. This highlights the critical role of nursing informaticists in advocating for system designs and optimizations that support nursing-specific tasks and improve usability for frontline clinicians. - Interoperability challenges are a major source of frustration, as incompatible systems across different facilities often require manual data re-entry, increasing the risk of errors. Informatics nurses can help bridge this gap by working on projects that streamline data exchange between different EHRs, imaging systems, and other clinical technologies.
