Breaking down HTI-1 and the future of health IT

The ONC published the final rule for “Health Data, Technology, and Interoperability: Certification Program Updates, Algorithm Transparency, and Information Sharing” (HTI-1) on Jan. 9, 2024, to update implementations related to the 21st Century Cures Act, expand interoperability, and promote health equity. 

Just like with other iterative regulatory requirements that participating facilities must adhere to, compliance with HTI-1 is mandatory. HTI-1 is designed to enhance decision-making and interoperability within health care systems. By participating in this program, your hospital can leverage data-driven responses to public health challenges and stay prepared for evolving standards and innovations.

What rural hospitals need to know about HTI-1

The HTI-1 final rule impacts rural hospitals by balancing the sharing of electronic health information (EHI) with patient privacy protections and legal considerations. The rule includes a “good faith belief” standard, allowing providers to withhold EHI if they genuinely believe sharing it could create legal risks. This helps rural hospitals and small practices avoid the burden of navigating complex legal requirements while still maintaining compliance with interoperability rules.

To ease administrative strain, HTI-1 keeps some documentation requirements but ensures they remain practical and flexible. Rural hospitals are not required to track every legal nuance, allowing them to focus on patient care rather than excessive paperwork. By supporting privacy, trust, and operational efficiency, HTI-1 helps rural hospitals meet interoperability standards without overwhelming their resources.

Key aspects of HTI-1 final rule

Algorithm transparency 

A notable feature of the HTI-1 final rule is its focus on algorithm transparency. It introduces first-of-its-kind requirements for transparency in artificial intelligence and other predictive algorithms included in certified health IT. This transparency is intended to enable clinical users to better understand and evaluate the tools they use for decision-making, ensuring these tools meet standards of fairness, validity, effectiveness, and safety.
 

Enhanced information blocking requirements 

The HTI-1 final rule revises the definitions and exceptions related to information blocking to foster a more efficient exchange of electronic health information. It introduces a new exception to promote secure, standards-based exchanges under the Trusted Exchange Framework and Common Agreement (TEFCA). The exception states that if both parties are participating in TEFCA and the vendor is fulfilling the health information request only through TEFCA, it is not considered information blocking.
 

New interoperability-focused reporting metrics 

The rule implements a new “insights condition” for certification, requiring developers of certified health IT to report on certain metrics to provide deeper insights into the usage of health IT in health care delivery.
 

Modifications to the certification program 

The HTI-1 final rule discontinues the use of year-themed editions for certification criteria, opting instead for a unified set of criteria that will be updated incrementally. This change aims to align the certification process more closely with the regular development cycles of health IT. Please note: HTI will continue to evolve, and health care facilities can expect to continue adopting incremental changes regularly. 

Understanding the base EHR requirements

An important aspect of meeting the base EHR definition is the ability to offer software certified to the ONC clinical decision support criteria. As of Jan. 1, 2025, hospitals must own software certified to the decision support intervention (DSI) criteria, and the current clinical decision support criteria will no longer be valid for meaningful use reporting.

What Are decision support interventions?

• Enhanced clinical decision-making: DSIs provide real-time, evidence-based recommendations such as alerts for potential drug interactions and treatment guidelines that improve patient safety and care quality.
• Conformance to the CMS Promoting Interoperability Program: Hospitals eligible to participate in the CMS Promoting Interoperability Program must own base EHR technology that supports evidence-based and predictive DSIs. HTI-1 is the current ONC rule that lists the latest required standards, vocabularies, and functional criteria for ONC software certification. 
• Preparation for future innovations: DSIs lay the groundwork for future integration of advanced technologies such as predictive analytics, helping hospitals stay at the forefront of health care innovation.
   

How can you prepare?

Hospitals face a challenging timeline to comply with these standards, underscoring the urgency of prioritizing technological upgrades. 

The rule sets forth clear deadlines for integrating enhanced interoperability features and adopting new data standards such as the USCDI v3 by Jan. 1, 2026. Early adoption can provide significant benefits, including: 

• Improved data interoperability for more efficient health information exchange. 
• Enhanced data management to support better patient outcomes. 
• AI technology to refine health care delivery and optimize operations. 
   

Given these factors, it is crucial for health care organizations to begin planning and implementing these upgrades promptly. 

To help health care organizations meet these new standards, the MEDHOST HTI Program offers a comprehensive suite of solutions designed to facilitate compliance and prepare your facility for the future. By adopting HTI-1 standards early, you can help your organization take full advantage of advancements in data management and health care delivery.

We’re pleased to share our latest e-book on the HTI-1 final rule, an essential resource for health care leaders who want to understand the rule, achieve compliance, and stay ahead in a rapidly evolving environment. This comprehensive guide is filled with critical insights and practical strategies to help you confidently navigate the complexities of HTI-1, including detailed timelines for successful implementation, how HTIl-1 will shape the future of health care data exchange, and strategies to avoid penalties and leverage new technologies.

NRHA adapted the above piece from MEDHOST, a trusted NRHA partner, for publication within the Association’s Rural Health Voices blog.