[Federal Register Volume 89, Number 208 (Monday, October 28, 2024)]
[Notices]
[Pages 85540-85545]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2024-24924]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Administration for Children and Families
Request for Information: Administration for Children and Families
Development of Interoperability Standards for Human Service Programs
AGENCY: Office of the Chief Technology Officer, Administration of
Children and Families, Department of Health and Human Services.
ACTION: Request for information (RFI).
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SUMMARY: The Administration for Children and Families (ACF), in the
U.S. Department of Health and Human Services (HHS), invites public
comments to inform the use or adoption of interoperability standards
for human services programs. ACF and state, local, and tribal
governments all provide a number of health and human services programs
for children, youth, families, communities, and individuals. ACF seeks
public comment on the most effective approaches, technical standards,
and technological tools that currently or could promote
interoperability between health and human services programs. ACF
collaborates with the Assistant Secretary for Technology Policy/Office
of the National Coordinator for Health Information Technology (ASTP/
ONC) as a critical steward and advisor for human services
interoperability with responsibility for leading the development and
harmonization of interoperability standards between health and human
services in line with the HHS Data Strategy. The potential of
interoperability across the full spectrum of health and human services
is immense--it can enable efficient delivery of government services,
enhance access to critical non-profit programs, and most importantly,
improve overall individual and community outcomes. ACF has authority
under the Title IV of the Social Security Act to designate use of
interoperable data standards for several of its programs (e.g.,
Temporary Assistance for Needy Families (TANF), child support, child
welfare, and foster care). The purpose of this RFI is to understand how
ACF, in collaboration with ASTP/ONC, can better support
interoperability between human services within and across states and
local community resources, between states, and ACF.
DATES: Comments are due within 60 days of publication.
ADDRESSES: Submit responses to [email protected], a federal mailbox
allowing the public to submit comments on documents agencies have
published in the Federal Register and are open for comment. Simply type
``ACF-2024-Interoperability-RFI'' in the Comment or Submission search
box, click Go, and follow the instructions for submitting comments.
Comments submitted in response to this notice are subject to the
Freedom of Information Act and may be made available to the public. For
this reason, please do not include any information of a confidential
nature, such as sensitive personal information or
[[Page 85541]]
proprietary information. If you submit your email address, it will be
automatically captured and included as part of the comment placed in
the public docket. Please note that responses to this public comment
request containing any routine notice about the confidentiality of the
communication will be treated as public comments that may be made
available to the public, notwithstanding the inclusion of the routine
notice.
SUPPLEMENTARY INFORMATION:
1. Background
The Administration for Children and Families (ACF) requests
comments to inform the use of interoperable data standards across human
services programs. This will improve the quality of service delivery
and increase efficiency in collaborations between agencies
administering ACF programs and other government and non-government
agencies that serve the same populations.
1.1 Regulation Development Process
The data exchange standardization requirements under the Social
Security Act Title IV programs of child welfare and foster care (Titles
IV-B and IV-E), child support (Title IV-D), and Temporary Assistance
for Needy Families (TANF, Title IV-A) result from Public Laws 112-
34,\1\ 112-96,\2\ 113-183,\3\ and 115-123.\4\ These laws require the
designation of interoperable standards for data that must be exchanged:
(1) between states and ACF; and/or (2) between states under specified
programs.
ACF's Office of the Chief Technology Officer (OCTO) will lead the
drafting of any regulations with respect to the programs described
above with subject matter expertise from ACF program offices including,
but not limited to, the Children's Bureau (CB), Family and Youth
Services Bureau (FYSB), Office of Early Childhood Development (ECD),
Office of Child Care (OCC), Office of Head Start (OHS), Office of Child
Support Services (OCSS), Office of Community Services (OCS), Office of
Family Assistance (OFA), and Office of Family Violence and Prevention
Services (OFVPS).
Additionally, OCTO will coordinate and consult on the input
received in response to this RFI both with the ASTP/ONC and with other
agencies executing programs and policies involving human services
interoperable data standards, such as the Centers for Medicare &
Medicaid Services (CMS), Administration for Community Living (ACL), and
the Health Resources and Services Administration (HRSA).
ASTP/ONC enable standards on behalf of HHS under section 3004 of
the Public Health Service Act (PHSA) in 45 CFR part 170 Subpart B. As
lead for the development and harmonization of interoperability
standards between health and human services, ASTP/ONC may enable
standards for human services which will be available for use by any HHS
program, including ACF. Adopting standards in one location for HHS use
enables alignment across HHS programs to further interoperability,
including alignment described under Sections 13111 and 13112 of the
Health Information Technology for Economic and Clinical Health Act
(``HITECH Act'') (Pub. L. 111-5, Title XIII, secs. 13111 and 13112).
1.2 For the Purposes of This Notice
Interoperability refers to the ability of different information
systems, devices, or applications to connect, in a coordinated way,
within and beyond organizational boundaries to access, exchange, and
use data in a cooperative way between stakeholders, with the aim of
optimizing the health and wellbeing of individuals and populations
(adapted from HIMSS, 2019).\5\ The definition of interoperability in
section 4003 of the 21st Century Cures Act calls for all electronically
accessible information to be accessed, exchanged, and used without
special effort on the user's part (Pub. L. 114-255).
Standards, for the purposes of this RFI, refer to any documented,
consistent, and repeatable method for exchanging data through technical
or non-technical means. There are technical standards for electronic
data exchange, such as through data exchange standards, including
Health Level Seven (HL7) Fast Healthcare Interoperability Resources
(FHIR[supreg]). There are also standards of practice in the context of
business processes, such as protocols for encryption, hashing, or
establishment of accessible websites. These standards of practice are
often codified in policies, interagency agreements, memoranda of
understanding, service-level agreements, etc.
Human Services Interoperability refers to the ability of health and
human service systems to exchange data for service planning,
coordination, delivery, monitoring, and evaluation in an automated,
standards-based, and integrated manner that improves outcomes for
children, families, and communities. Human services refer to programs
that may not exclusively be provided or funded by HHS but may include
those funded through other federal agencies. Human services include a
wide variety of programs and services to enhance the quality of life,
promote well-being, and address the needs of individuals and
communities.
1.3 Purpose of Interoperable Data Standardization for Interoperability
The purpose of designating interoperable data standards is to
ensure all parts of the human services delivery ecosystem can
effectively and efficiently exchange information between and among
programs for seamless service delivery. Effective and efficient
information exchange can help appropriately reach people and deliver
the right benefits, supporting coordinated case management, benefits
enrollment, and new service delivery models. Interoperability promotes
many objectives, from the availability of higher quality, more recent
data that can be used to appropriately reach people and deliver the
right benefits to coordinated case management, benefits enrollment, and
new service delivery models.
Using timely and quality data, for example, a child welfare
caseworker might be able to retrieve a family's current address from
child support data to locate the family for an in-person visit or
locate the non-custodial parent for possible placement of the children.
Interoperable data standards between a public child welfare agency with
care and custody of a child and a foster care placing agency could
ensure both agencies have the most current information on the child in
care. Interoperability can also help identify if household composition
has changed, or a recipient has moved out of state, and changes to
benefits levels are needed. For example, if a parent was reunited with
their children exiting foster care, data sharing across information
systems would allow the TANF agency to update the benefit eligibility
for the family. Widespread adherence to data standards can enable
better interoperability and reduce the burden of connecting disparate
systems containing the information described in this example.
Interoperable data standards can also help to facilitate
initiatives. For example, a Medicaid applicant works with a health
insurance navigator during the annual Marketplace enrollment period and
participates in a Social Determinants of Health (SDOH) questionnaire
with the navigator, who recognizes that the applicant is experiencing
challenges in securing adequate food and necessary clothing. The
navigator could pre-fill an enrollment application for SNAP benefits
and provide information to complete the enrollment. Also, the
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navigator can provide the Medicaid applicant with the local food bank's
name, location, phone number, and a resource for the community clothing
closet. Further, with the Medicaid applicant's consent, the navigator
can send an electronic message or alert to the local non-profits
identified in a statewide network of non-profit community resources,
allowing receiving organizations to reach out to the applicant to
determine if they need additional support to get connected with
services. Common standards can help simplify the complex interactions
between different systems described in this scenario and ensure
scalability as new entities seek to participate in the exchange.
ACF believes that designating nationally recognized interoperable
data standards in the programs described above will make it easier to
share data across multiple organizations. While likely more effective
and cost-effective in the long run, ACF also recognizes that this
approach may initially involve financial and time costs related to
updating proprietary systems to use open standards. Therefore, as part
of any future ACF programmatic and policy development, and in
coordination with ASTP/ONC, ACF seeks to strike the appropriate balance
between the benefits of interoperability and standardization and ease
of implementation.
2. Legal Authority
Federal statutes require ACF to designate interoperable data
standards to promote data exchange in state human services programs at
the state level and with the federal government. Most recently, the
Family First Prevention Services Act (FFPSA), enacted as part of Public
Law (Pub. L.) 115-123, authorized optional Title IV-E funding for time-
limited prevention services for mental health, substance abuse, and in-
home parent skill-based programs for children or youth who are
candidates for foster care, pregnant or parenting youth in foster care,
and the parents or kin caregivers of those children and youth. This law
amended Title IV-B of the Social Security Act to require that ACF must
``designate data exchange standards to govern . . . (1) necessary
categories of information that State agencies operating programs under
State plans approved under this part are required under applicable
Federal law to exchange with another State agency electronically; and
(2) Federal reporting and data exchange required under applicable
Federal law'' (42 U.S.C. 629m(a)).
The statute further provides that ACF shall incorporate, to the
extent practical, interoperable standards developed and maintained by
intergovernmental partnerships and federal agencies with authority over
contracting and financial assistance. The data exchange reporting
standards shall incorporate a widely accepted, nonproprietary,
searchable, computer-readable format; be consistent with and implement
applicable accounting principles; be implemented in a manner that is
cost-effective and improves program efficiency and effectiveness; and
be capable of being continually upgraded as necessary (42 U.S.C.
629m(b)).
Additionally, ACF coordinates with the ASTP/ONC in a manner
consistent with Sections 13111 and 13112 of the HITECH Act to ensure
alignment across HHS and non-HHS agencies around health IT standards
ASTP/ONC adopts on behalf of HHS under section 3004 of the PHSA in 45
CFR part 170 Subpart B. ACF coordinates with ASTP/ONC pursuant to the
provisions of the HITECH Act above when adopting, implementing, or
upgrading health IT systems used for the direct exchange of
individually identifiable health information between agencies and non-
Federal entities.
The extent of data elements that need to be shared to enable
improved service delivery and program management often exceeds the
minimum legal requirements. As described throughout ACF's
Confidentiality Toolkit \6\ in the Applicable Federal Legislation
sections, data sharing beyond the minimum regulatory requirements (as
referenced throughout this RFI) is permissible and encouraged when
practical use cases exist.
3. Current Interoperability Standards and Initiatives
3.1 FHIR and Gravity Project
HL7[supreg] Fast Healthcare Interoperability Resources
(FHIR[supreg]) is a rapidly maturing interoperability standard based on
modern internet technology approaches. FHIR goes beyond document-level
interoperability to data element-level exchange. It uses standardized
application programming interface (API) standards to facilitate
interoperable data standards, enabling more efficient application
development across multiple device types. There is a growing open-
source community developing around FHIR implementation.\7\
Today, several stakeholder efforts are underway to extend the use
of FHIR to support the interoperability of human services information.
For instance, the Gravity Project \8\ is a stakeholder-led initiative
to identify and harmonize social risk factor data for interoperable
electronic health information exchange. The HL7 Gravity Accelerator \9\
established codes for data elements such as housing instability, food
insecurity, transportation insecurity, etc. It creates a common
terminology for exchanging content related to non-medical factors
influencing health and human services outcomes. Another HL7 group is
the Health and Social Services (HSS) Work Group, supported by ACF,
which is focused on facilitating human services data content further. A
project description of Enhancing the FHIR for Social Services and
Social Determinants (EFSS) and a list of use cases can be found in
Appendices 1 and 2.
3.2 United States Core Data for Interoperability (USCDI/USCDI+)
In the 21st Century Cures Act: Interoperability, Information
Blocking, and the ONC Health IT Certification Program final rule (85 FR
25642) \10\ published in May 2020, ASTP/ONC adopted the United States
Core Data for Interoperability (USCDI) \11\ standard, which describes a
standardized set of health data and constituent data elements for
nationwide, interoperable health information exchange (85 FR 25669).
USCDI is implemented in FHIR by mapping data elements and value sets to
FHIR resources and implementation guides through the US Core
Implementation Guide.\12\ ASTP/ONC published Version 3 of the USCDI in
July 2022 \13\ and subsequently adopted Version 3 as the new baseline
for the ASTP/ONC Certification Program in the Health Data, Technology,
and Interoperability: Certification Program Updates, Algorithm
Transparency, and Information Sharing (HTI-1) Final Rule (89 FR 1210).
Version 3 included new data elements for social determinants of health
(SDOH), which includes SDOH Problems/Health Concerns, SDOH
Interventions, SDOH Goals, and SDOH Assessments. USCDI Version 4,
published in July 2023,\14\ added 20 data elements to help address and
mitigate health and healthcare inequities and disparities. Additional
priorities for USCD v4 were to address underserved communities' needs,
behavioral health integration with primary care and other physical
care, and public health interoperability needs of reporting,
investigation, and emergency response.
Further, ASTP/ONC oversees the USCDI+ \15\ initiative to support
identifying and establishing domain, or program-specific, datasets that
build on the existing USCDI. Specifically, USCDI+ is a service that
ASTP/ONC
[[Page 85543]]
provides to federal and industry partners to establish, harmonize, and
advance the use of interoperable datasets that extend beyond the core
data in the USCDI to meet specific programmatic and/or use case
requirements. This approach allows ASTP/ONC to assure that new datasets
build from the same core USCDI foundation, and allows for alignment of
similar data needs across agency programs and corresponding data users
and/or participants at the state and local levels.
3.3 Human Services Interoperability Innovations (HSII) Demonstration
Program
ACF has focused on programmatic investments to advance human
services interoperability. ACF's Human Services Interoperability
Innovations (HSII) demonstration program \16\ was intended to expand
data-sharing efforts by state and local governments, tribes, and
territories to improve human services program delivery and to identify
novel data-sharing approaches that can be replicated in other
jurisdictions. These investments enabled ACF to fund entities to focus
on addressing longstanding barriers to interoperability through
cooperative agreements for the HL7 Care Plan for Maternal Opioid Misuse
and the implementation of FHIR operating systems necessary to support
Centers for Medicare and Medicaid Innovation (CMMI) Integrated Care for
Kids model grantees in both New Jersey and Connecticut.
3.4 HL7 Human and Social Services (HSS) Workgroup
ACF led the creation of the HL7 Human and Social Services (HSS)
Workgroup.\17\ The HSS Workgroup's mission is to provide a space to
design and validate HL7 interoperable human services data standards.
The group is also developing a common format for social services
provider directory information. This project maps the definitions from
Open Referral to the FHIR standard using an FHIR Facade before the
Human Services Data API (HSDA).
4. Proposed Direction for Developing Interoperable Data Standards
The health sector has increasingly looked to FHIR as a core
standard, catalyzed by the industry's embrace of FHIR and codified
through the incorporation of ASTP/ONC-certified health IT systems
featuring FHIR APIs into CMS program requirements for use of certified
electronic health record technology (CEHRT) (for instance, Medicare
Promoting Interoperability Program and the Promoting Interoperability
performance category of the Merit-Based Incentive Payment System
(MIPS)),\18\ and ASTP/ONC's efforts to incorporate FHIR as part of the
technical requirements for the Trusted Exchange Framework Common
Agreement (TEFCA).\19\ Given the need for human services data to be
interoperable with health data to support integrated case management at
the person level and in light of the opportunity to significantly
leverage health sector infrastructure such as Qualified Health
Information Networks (QHINs) and existing data exchange pathways using
FHIR, ACF is considering the HL7 FHIR standard as the foundation of
data interoperability for ACF-covered domains.
5. Request for Information
ACF seeks a more interoperable human services data ecosystem with
available and shareable data between care providers, programs, and the
government to drive improved outcomes for children and families. To
deliver that goal, more consistent use of interoperable standards and
practices is needed at all levels. ACF recognizes that organizations
may be limited in major IT system transitions without significant new
funding. However, without government-backed standards, pilots, and
processes, the current and future IT systems will maintain and even
accelerate their current degree of fragmentation. Therefore, ACF is
seeking input on how to support a drive toward interoperability across
the field in economical, efficient, effective, and reasonable ways.
ACF also seeks feedback on proposed initial domain focus areas for
standards development and pilots. These focus areas may encompass areas
where HHS/ASTP/ONC and ACF have formal regulatory powers to set
standards for child welfare and foster care as well as prevention,
adoption and guardianship (Title IV-B and IV-E), child support (Title
IV-D), and Temporary Assistance for Needy Families (TANF, Title IV-A).
It also includes areas where ACF could engage more actively with
standards development organizations, such as the HL7 Human and Social
Services (HSS) Workgroup (currently focusing on food, housing, and
economic insecurity as its priority use cases). We are interested in
receiving input affecting additional programs.
ACF requests comments on the following topics. Please comment or
respond to any questions that apply from the perspective of your
agency, organization, program, or setting; commenters are not required
to respond to every question:
Input on specific topics
1. Practical enablers of/or barriers to interoperability:
1.1 Provide examples of the key enablers and/or inhibitors to using
interoperable human services data standards (including data content and
data exchange) in your program or agency.
1.2 How is the ability to exchange human services data impacted by
state or federal law, policies, or other governing frameworks
(including CMS Interoperability rules)?
1.3 What is the highest priority legal, policy, or governance
issues to be addressed when moving to an interoperable ACF environment?
(e.g., minor consent, guardianship, Family Education Rights and Privacy
Act (FERPA), privacy, security, sensitive data, parental controls,
etc.)
1.4 Describe any mitigation strategies or policy levers that have
effectively moved interoperable human services data exchange forward in
your organization, state, or program.
2. Impact of lack of human services interoperable data
standardization: Provide examples of existing and planned human
services interoperable data efforts and to what degree, if any, does a
lack of standardization negatively impact them.
2.1 What interoperable data standards are being used today in ACF-
funded programs?
2.2 Describe any impediments experienced in current systems when
accessing, analyzing, or sending data to the federal level.
2.3 What are the benefits of moving to a common interoperable data
standard like Fast Healthcare Interoperability Resources (FHIR)?
3. Care coordination: ACF seeks comments on current care
coordination activities and data standards to support the interoperable
data exchange for service delivery, operations, and reporting.
3.1 How do you currently use interoperable data to support care
coordination across human services, both between human services
programs and between human services and health services? For example,
are you able to collect medical data for children who have medical
issues?
3.2 Describe use cases that benefit from interoperable data
standards for advancing service coordination activities among state and
federal programs (e.g., clinical, administrative, operations). Tell us
about systems currently used that are API-enabled.
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3.3 What are the most important use cases where interoperable data
standards or exchange protocols must be piloted/validated?
3.4 What federal support would be necessary or helpful to catalyze
those efforts?
4. Interoperable data standards needed for operations and
reporting: ACF recognizes that not all systems operate using
interoperable data standards, and as a result, not all applications are
capable of data exchange. Since 2021, ACF has sponsored an HL7 Human
and Social Services (HSS) workgroup to develop data standards using
FHIR specifications for Human and Social Services.
4.1 What ACF domains or programs would benefit from using an
interoperable data standard for business operation and reporting?
4.2 To what extent is the HL7 or the HL7 FHIR standard used in ACF
programs today?
4.3 Will your organization experience specific benefits or
drawbacks if an interoperable data standard like FHIR is widely used in
ACF programs?
4.4 Should any domain or program be exempt from using a standard
like FHIR?
5. Standards in practice: In cases where human services data
systems currently use interoperable data standards, describe how they
do or do not incorporate the following:
5.1 Interoperable standards developed and maintained by an
international voluntary consensus standards body such as HL7.
5.2 Interoperable standards developed and maintained by
intergovernmental partnerships such as the National Information
Exchange Model (NIEM).
5.3 Interoperable standards developed and maintained by specific
federal agencies with authority over contracting and financial
assistance.
6. Intra- and inter-state human services data sharing: Describe the
types of human services agencies in your state that electronically
exchange with other states, state agencies, or community organizations
in healthcare or human services within your state.
6.1 How are they aligned, or not, with a specific industry
standard(s), e.g., FHIR, to ensure ease of access and use of
interoperable data?
6.2 What types of systems and non-proprietary, open-data standards
are used to facilitate interoperability across programs?
6.3 Are there tools in use for normalizing and/or harmonizing data
to standards?
6.4 Tell us about any significant data quality and matching issues
to be addressed to make the data exchange meaningful.
6.5 What additional infrastructure would need to be developed to
ensure that data is interoperable and actively exchanged?
7. Funding: Describe current funding mechanisms that support or
hinder interoperable data systems' design, development, and
implementation.
7.1 What types of funding have you leveraged to design, develop,
and implement interoperable data systems (e.g., Advance Planning
Documents and grants)?
7.2 What incentives or requirements would be needed to drive key
use cases of data exchange once systems are interoperable (e.g., data
quality and/or identity management)?
7.3 What barriers or challenges have you encountered with these
funding mechanisms?
8. Technical Assistance: What technical assistance have you
leveraged in designing, developing, and implementing interoperable data
systems?
8.1 What technical assistance (such as subject matter expertise in
data standards and coding/software development) would be necessary to
move to an interoperable standard like FHIR?
8.2 What top actions should the federal government take to provide
technical assistance to encourage human services interoperability?
9. United States Core Data for Interoperability (USCDI/USCDI+):
Provide input to inform how ACF may identify, create, and standardize
human services data elements leveraging the ASTP/ONC USCDI+ initiative,
HL7 FHIR, and relevant HHS policy levers, including applicable
regulations, to improve interoperability for human services programs.
9.1 How could an initiative such as USCDI+ be leveraged to harmonize
human services data needed for care coordination, program evaluations,
and reporting requirements?
9.2 What is the highest priority use case(s) that need further
development in USCDI+ and FHIR to address ACF's stakeholders' needs?
9.3 What data elements are a high priority to enable comprehensive
case management, including whole-person care, referrals, and research?
9.4 What technical and policy approaches effectively link human
services data to health IT codes and value sets to help improve
interoperability, and use across multiple systems and domains?
10. General questions--Provide input on the current state of data
that your organization receives and/or exchanges.
10.1 What information do you exchange, if any, and from whom?
10.2 What information to you currently collect and from whom?
10.3 What information do you need to exchange, that you have
trouble exchanging and with whom? How does that challenge impact your
work, community, etc.?
11. Other considerations: ACF welcomes comments on other aspects of
recognizing and establishing interoperable data standards for human
services programs you wish to provide.
Kevin M. Duvall,
Chief Technology Officer, Administration of Children and Families.
Endnotes
\1\ Public Law 112-34--Child and Family Service Improvement and
Innovation Act. (2011). Retrieved from https://www.govinfo.gov/app/details/PLAW-112publ34/summary.
\2\ Public Law 112-96--Middle Class Tax Relief and Job Creation
Act. (2012). Retrieved from https://www.govinfo.gov/app/details/PLAW-112publ96/summary.
\3\ Public Law 113-183--Preventing Sex Trafficking and
Strengthening Families Act. (2014). Retrieved from https://www.govinfo.gov/app/details/PLAW-113publ183/summary.
\4\ Public Law 115-123--Bipartisan Budget Act of 2018. (2018).
Retrieved from https://www.govinfo.gov/app/details/PLAW-115publ123/summary.
\5\ Health Information Management Systems Society:
Interoperability Definition. (2021). Retrieved from HIMSS writes new
definition of interoperability--Digital-health.
\6\ Administration of Children and Families (ACF):
Confidentiality Toolkit. (2021). Retrieved from https://www.acf.hhs.gov/opre/report/confidentiality-toolkit.
\7\ Redox. Popular Open Source FHIR Libraries. (2021). Retrieved
from https://www.redoxengine.com/blog/popular-open-source-fhir-libraries/.
\8\ Health Level Seven (HL7) Confluence. (2023). The Gravity
Project. Consensus-driven standards on social determinants of
health. Retrieved from https://confluence.hl7.org/display/GRAV/The+Gravity+Project.
\9\ HealthITbuzz. (2022). FAST Continues FHIR Scalability Work
as a New HL7 FHIR Accelerator. Retrieved from https://www.healthit.gov/buzz-blog/health-it/fast-continues-fhir-scalability-work-as-a-new-hl7-fhir-accelerator.
\10\ National Archives Federal Register. (2020). 21st Century
Cures Act: Interoperability, Information Blocking, and the ONC
Health IT Certification Program. Retrieved from https://
www.federalregister.gov/documents/2020/05/
[[Page 85545]]
01/2020-07419/21st-century-cures-act-interoperability-information-
blocking-and-the-onc-health-it-certification.
\11\ Office of the National Coordinator for Health IT. (2023).
United States Core Data for Interoperability (USCDI). Retrieved from
https://www.healthit.gov/isa/united-states-core-data-interoperability-uscdi.
\12\ Office of the National Coordinator for Health IT. (2023)
United States Core (US Core) Fast Healthcare Interoperability
Resources (FHIR) Retrieved from https://hl7.org/fhir/us/core/history.html.
\13\ Office of the National Coordinator for Health IT. (2023)
United States Core (US Core) Fast Healthcare Interoperability
Resources (FHIR) Retrieved from https://hl7.org/fhir/us/core/history.html.
\14\ Office of the National Coordinator for Health IT. (2023).
United States Core Data for Interoperability. Retrieved from https://www.healthit.gov/isa/sites/isa/files/2023-10/USCDI-Version-4-October-2023-Errata-Final.pdf.
\15\ Office of the National Coordinator for Health IT. (2023).
United States Core Data for Interoperability Plus (USCDI+).
Retrieved from https://www.healthit.gov/topic/interoperability/uscdi-plus.
\16\ Office of Planning, Research and Evaluation an Office of
the Administration of Children & Families. (2023). Human Services
Interoperability Innovations (HSII). Retrieved from https://www.acf.hhs.gov/opre/project/human-services-interoperability-innovations-hsii-2020-2021.
\17\ Health Level Seven (HL7) Confluence. (2023). Human and
Social Services Home. Retrieved from https://confluence.hl7.org/display/HSS/Human+and+Social+Services+Home.
\18\ Centers for Medicare & Medicaid Services. (2020). CMS
Interoperability and Patient Access Final Rule (CMS-9115-F).
Retrieved from https://www.cms.gov/interoperability/policies-and-regulations/cms-interoperability-and-patient-access-final-rule-cms-9115-f.
\19\ The Sequoia Project. (2022). FHIR Roadmap v1.0. Retrieved
from https://rce.sequoiaproject.org/wp-content/uploads/2022/01/FHIR-Roadmap-v1.0_updated.pdf.
[FR Doc. 2024-24924 Filed 10-25-24; 8:45 am]
BILLING CODE 4184-01-P