AHA Urges Feds to Slow Health IT Overhaul

The push from the American Hospital Association (AHA) centers on a proposed rule from the Office of the National Coordinator for Health IT (ONC), intended to advance health data interoperability. This overhaul, part of the Health Data, Technology, and Interoperability (HTI) framework, aims to move the health IT certification program more aggressively toward modern standards like Fast Healthcare Interoperability Resources (FHIR). A key component of the federal strategy is the HTI-1 Final Rule, which took effect in March 2024. This rule establishes transparency requirements for AI and predictive algorithms in certified health IT, implements new interoperability reporting metrics for developers, and adopts the United States Core Data for Interoperability (USCDI) Version 3 as the new baseline data standard, effective January 1, 2026. The AHA's primary objection is to the proposed timeline, which it deems unrealistic, and has requested at least a 24-month window for the transition after final rules are published. A major point of contention is the proposal to eliminate the requirement for health IT to support the older Consolidated Clinical Data Architecture (C-CDA) standard. The AHA argues that many providers, especially in rural and underserved areas, still heavily rely on C-CDA for data exchange. Another significant concern for the AHA is the proposed removal of all 13 privacy and security certification criteria. The association contends that with cybersecurity threats at an all-time high, eliminating these baseline requirements would shift the burden of risk and potential costs directly onto healthcare providers. The AHA is also pushing back on the elimination of certification criteria related to decision support interventions, particularly transparency requirements for AI-driven tools. Hospitals depend on these standards to understand the development, testing, and evaluation of the algorithms they use. Furthermore, the group opposes scaling back real-world testing requirements for health IT products, arguing that lab simulations are insufficient to ensure functionality in live clinical environments. The ONC's changes are part of a broader effort to implement the 21st Century Cures Act, which aims to improve the access, exchange, and use of electronic health information. The HTI-1 rule also discontinues the year-themed edition naming convention for certification criteria, moving to a more incremental update process to better align with health IT development cycles. The rule introduces an "Insights Condition," requiring certified health IT developers to report on specific interoperability metrics. This is intended to increase transparency and provide a clearer picture of how certified technologies are used in practice. Beyond the certification overhaul, the AHA is also advocating for the repeal of information blocking disincentives that can lead to reduced Medicare payments for providers. The association argues these penalties are excessive and could be destabilizing for smaller and rural hospitals.