1. The ONC, along with others identified by the ONC within the DHHS, should incorporate a CHR into its future Learning Health System and Interoperability Roadmap aims.

2. The ONC should lead the relevant parties and convene a Community Health Record Working Group to identify the groups currently working on community health standards, and harmonize the standards for health and quality-of-life descriptions and measurements that define the baseline CHR.

3. The standards should include data needed to describe national, state, and local health and determinants of health and not simply recommend currently existing national sourced indicators. Place-based data, at an increasingly local granular level (county, city, zip code, tract or block) are needed to properly understand the distribution of health in a community. An investment may be needed to collect these data. As with the evolution of EHR standards, the collection of increasingly geographical granular data may be phased in over time.

4. The ONC should consider using the results of the Community Health Record Working Group to propel the standards for interoperability within existing SDOs upon which the public and private sectors can build, act, and innovate. This should include developing a robust data model of the identified health and health determinant categories.

5. CHR standards should include flexibility for the inclusion of new metrics and data based on the needs and special characteristics of a given region or population; that is, the ability to add local data and have a process for periodic national review of incorporating new data elements into the CHR standards.

6. CHR standards should work toward improving the consistency of data-collection methods across communities to improve data reliability and comparability.

7. The ONC or another government entity should establish a method for sharing best practices related to data collection and reporting among communities and organizations working to improve population health. As an example, this may include guidelines for reporting data, such as the aggregation of data across multiple years to arrive at stable rates. These data-collection and reporting best practices may be developed and encouraged through grants, incentives, technical assistance, rewards and recognition, and competitions. Support should be provided to ensure that CHRs are based on continually improved data sources.

8. The ONC or another government entity should continue the excellent work with the open data initiative, and (1) continue encouraging government agencies and other organizations to release more health and quality-of-life data and (2) continue establishing APIs, exposing access to the data and allowing for more interoperability and data sharing. Also important is enabling third parties and application developers to add value (presentation of data, combination of data sets, higher-level analytics) for those interested in using this information to improve insights into the health of populations.

9. CHR standards should mandate inclusion of standard conventions for time-stamping data (both when collected and when reported) within all published community health data. Furthermore, CHRs should have the capacity to interoperate with other data provenance standards as being spearheaded by the ONC.

10. CHR best practices must be based on community health, broadly defined, and as such should include indicators related to the environment, the economy, education, transportation, and other factors relating to health and quality of life, such as access to fresh food and housing availability.

11. For all relevant federally supported activities, the government should phase in requirements for assessing and using CHR data best practices, such as reporting for hospital IRS 990 requirements and public health department PHAB requirements.

12. Upon formalization of CHR standards, government agencies should require applicable federal grant recipients to use CHR standard data for statements of need and impact assessment.

13. Educational institutions and workforce development programs, such as schools of public health and hospital administration programs, should incorporate CHR training. This will help cultivate a new breed of experts trained in both CHR technology and the application of that technology to drive community health best practices. Coursework should also include basic systems reengineering principles for quality and system improvement.

14. Stakeholders working in the field of population health should work together to increase both the quantity and quality of community health data, including those with government funding for research grants and awards or nonprofit organizations also collecting relevant data.

Note. API = applied program interface; CHR = community health record; DHHS = Department of Health and Human Services; EHR = electronic health record; ONC = Office of the National Coordinator for Health Information Technology; PHAB = Public Health Accreditation Board; SDO = Standards Developing Organization.