HTI-2 Proposed Rule: The Future of Public Health Interoperability

Imagine a world where healthcare data flows effortlessly, from hospital to home, connecting every doctor, clinic, and device in a seamless network dedicated to patient care. In this world, doctors have instant access to real-time data, patients can effortlessly engage with their health information, and health systems are no longer burdened by clunky, outdated tech. This vision of connected, efficient healthcare is what HTI-2—a new proposed rule by the Office of the National Coordinator for Health Information Technology (ONC)—promises to bring.

Today, we’re exploring what the HTI-2 proposed rule could mean for HealthTech in 2024, why it’s such a groundbreaking shift, and how it might just transform the way we deliver and experience healthcare.

HTI-2: Transforming HealthTech Interoperability

HTI-2, or the Health Data, Technology, and Interoperability rule, is still in the proposal stage, but it aims to address information blocking in certified health records. It’s the next step in a journey that began years ago, aimed at making health data as accessible and dynamic as the apps on our phones. The ONC launched HTI-2 as an upgrade to its predecessor, HTI-1, with new, expanded standards that go beyond hospital walls to connect public health agencies, payers, and even patients.

But this isn’t just an incremental update—it’s a leap forward in how we think about healthcare connectivity and the importance of certified health technologies. With HTI-2, the ONC is saying that everyone involved in healthcare, from doctors to tech developers to patients, deserves a place in this data-driven ecosystem.

Real-Time Health Data Exchange with FHIR Subscriptions

In today’s digital world, almost everything happens in real-time—except in healthcare, where information blocking remains a challenge. Want to book a flight or check the news? It’s instant. But in healthcare, outdated systems can make accessing real-time data feel like a distant dream. That’s where HTI-2 steps in, proposing features like FHIR Subscriptions to improve information sharing across healthcare systems. For the first time, health apps will be able to subscribe to patient events and receive live updates as soon as they happen.

Imagine a telemedicine app that can instantly alert a care team when a patient’s test results are ready or a monitoring device that flags abnormal readings in real-time, enhancing patient engagement. This isn’t just about convenience; it’s about catching critical changes before they escalate, giving patients the immediate care they need and keeping doctors in the loop every step of the way through health IT certification.

Expanding HealthTech Interoperability Beyond Health Systems

HTI-2 isn’t just focusing on hospitals—it’s casting a wider net, bringing in public health agencies and insurers. For years, public health interoperability and payer systems have worked in silos, making it difficult to gather holistic insights across the entire healthcare landscape. With HTI-2, the ONC aims to change that by expanding its certification requirements to include these sectors.

Why does this matter in the context of prior authorization and health IT certification? Because when public health, payers, and providers are working on the same digital page, we can identify trends, respond to outbreaks faster, and make healthcare more efficient for everyone involved, ultimately reducing information blocking. Think of it as shifting from isolated health systems to a connected health ecosystem—one that finally works together for the greater good of public health data sharing.

Clinical Decision Support Integration in HealthTech with CDS Hooks

One of HTI-2’s standout features is its focus on Clinical Decision Support (CDS) Hooks, which will enhance patient engagement. With this feature, clinical apps can integrate directly into a doctor’s workflow, providing timely insights when they’re most needed. Imagine a doctor reviewing a patient’s chart and seeing suggestions for evidence-based treatments right there in the system, enhancing patient engagement without needing to switch between apps or consult separate sources. It’s real-time, actionable support, where and when it’s most critical, especially in the context of the final rule.

For HealthTech developers, CDS Hooks open up endless possibilities to build tools that not only inform but enhance decision-making in ways that directly impact public health data outcomes.

Building a Unified Health Data Network with TEFCA

Underpinning HTI-2’s ambition is something called the Trusted Exchange Framework and Common Agreement (TEFCA), which is crucial for addressing information blocking. It’s a mouthful, but the idea is simple: create a common set of principles and standards that everyone in healthcare can use to share data. Imagine TEFCA as the universal “language” of healthcare data exchange—when everyone speaks the same language, data flows more freely, more securely, and with fewer barriers, facilitating public health interoperability.

While TEFCA is still voluntary, the HTI-2 proposed rule lays the technical and policy groundwork to make this vision a reality. It’s the beginning of a network that could one day allow health data to move as easily as email—safely and securely, but without friction, promoting information sharing.

Challenges and Future of HTI-2 in HealthTech

Of course, no proposal, including the HTI-2 rule, is without its challenges. One of the most significant limitations of HTI-2 in its current form is its lack of “write-back” capabilities, meaning that while apps can read data, they still face restrictions on adding data back into electronic health records (EHRs). This restricts certain two-way interactions that could make health applications even more powerful, such as allowing wearable devices to log real-time updates directly into certified health records.

Additionally, the ONC's HTI-2 proposed rule will require significant effort from developers, especially for small HealthTech firms seeking health IT certification. The ONC’s certification standards aim to bring everyone on board, but expanding the requirements to include public health and payer software could strain resources, particularly for newer or smaller companies.

But even with these challenges, HTI-2’s vision remains clear: a more connected, more capable healthcare system, where data flows like never before.

Preparing for a Future with HTI-2 HealthTech Standards

As HTI-2 progresses from proposal to potential reality, it’s more than a regulatory update—it’s a new chapter for certified health technologies. If finalized, HTI-2 will reshape how we build, share, and use health data. HealthTech developers have an incredible opportunity to be part of this journey, helping create a world where healthcare data flows seamlessly, patients receive timely care, and every innovation brings us closer to a future of proactive, connected health.

For HealthTech companies, the time to start preparing is now. The ONC is listening, welcoming feedback and insights to shape the rule’s final version. Whether you’re building a new health app or supporting a large health system, understanding HTI-2’s vision and engaging in the conversation is key to thriving in this future-focused landscape.

Closing Thoughts

HTI-2 isn’t a finished product—it’s a proposed blueprint for a new kind of healthcare that emphasizes public health interoperability and core data for interoperability. If you’re a developer, a provider, or simply someone passionate about the future of health, HTI-2 offers a glimpse of what’s possible when we break down barriers, connect systems, and let data work for us. With real-time alerts, seamless data flows, and a more unified health ecosystem, HTI-2 could very well be the start of a new era in HealthTech.

Let’s get ready for a future where every update, every alert, and every decision is powered by the promise of connected, patient-centered healthcare.