Advancements in Health IT: Enhancing Imaging Interoperability Standards

On January 30, 2026, the Assistant Secretary for Technology Policy and the Office of the National Coordinator for Health Information Technology (ONC) issued a Request for Information (RFI) soliciting feedback on establishing diagnostic imaging interoperability standards within the ONC Health IT Certification Program. This initiative follows the HTI-5 Proposed Rule on Health Data, Technology, and Interoperability from December and the recent release of the Draft U.S. Core Data for Interoperability Version 7 (USCDI v7) on January 29.

These advancements underscore the continuous efforts to achieve comprehensive interoperability in U.S. health IT systems, striving towards integrated longitudinal health records. Such records aim to enhance personalized and patient-centered care. Since its founding by Executive Order 13335 in 2004, the ONC has been dedicated to promoting the seamless exchange of electronic health information to improve healthcare quality and efficiency.

Over the last two decades, federal regulations such as the HITECH Act, ACA, MACRA, and the 21st Century Cures Act have shaped the ONC’s Health IT Certification Program, significantly aiding the widespread adoption of electronic health records (EHRs). Despite progress, the sector faces data silos where information exchange, though technically achievable, remains fragmented.

The imaging interoperability RFI tackles persistent issues in healthcare, including the reliance on outdated systems and inconsistent metadata practices. Diagnostic imaging data, typically managed in systems like PACS or VNAs, often remain separate from the EHR, while radiology reports are integrated within. The RFI seeks alternatives to traditional certification standards that could worsen data silos, advocating for unifying imaging data within a comprehensive clinical data layer.

The HTI-5 Proposed Rule indicates a transition towards flexible standards promoting API-driven interoperability, better aligning with the ONC's goals of enhancing data sharing and fostering innovation. While certification has standardized health IT functionalities, the ecosystem now necessitates approaches supporting more robust clinical interoperability.

Stakeholders are encouraged to engage in policy development that integrates imaging with broader interoperability frameworks. The USCDI v7 draft addresses this by proposing new data elements for diagnostic imaging, although it doesn't fully encapsulate all clinical data. As imaging interoperability policies progress, a comprehensive clinical data model becomes essential to prevent fragmented patient records, with the RFI representing a strategic opportunity to steer policy towards a flexible, vendor-neutral data architecture.

Enhanced longitudinal data infrastructure is crucial for advancing healthcare research capabilities and maintaining the U.S.'s leadership in data-driven medicine. Such advancements support innovation and are vital for the progression of precision medicine, ultimately reshaping the healthcare landscape.