Operating Cost of ASTP/ONC HTI-1 DSI Source Attribute Review

What HTI-1 DSI Requirements Cost to Operate at Community Hospital Scale

A community hospital COO operating a certified EHR has watched HTI-1 take effect through 2025. The DSI requirements affect operations beyond the vendor's certification work. The COO needs to know what the ongoing operational cost looks like.

What follows is the plain-English version.

The Five Cost Components of HTI-1 DSI Operations

• DSI inventory. Identifying activated DSIs in the EHR, both evidence-based and predictive. Annual cost in the low five figures (clinical IT time, periodic refresh).

• Source attribute review. For each predictive DSI, documented review of source attributes the vendor provides. Annual cost in the low to mid five figures depending on number of activated predictive DSIs.

• Clinician training. Training the clinical team on DSI use, limitations, and the role of source attributes in interpretation. Annual cost in the low five figures.

• Workflow governance. DSI activation decisions, override pattern monitoring, and integration with clinical decision support governance. Modest dollar; meaningful clinical leadership time.

• Vendor coordination. EHR vendor engagement on source attribute updates and DSI changes. Modest cost.

Total annual operational cost for a community hospital with moderate clinical AI footprint: mid five figures.

The Three Artifacts HTI-1 Operations Produce

Three artifacts the operation produces.

• A DSI inventory documenting activated interventions with classification (evidence-based or predictive), source attribute review status, and ownership.

• A source attribute review log capturing what was reviewed, who reviewed, and the decisions reached.

• Clinician training records documenting workforce competence on DSI use.

Together these support certification surveys, regulator inquiry, and broader clinical governance.

What the COO Controls in HTI-1 Operations

The COO controls four things in HTI-1 operations.

The first is the inventory completeness. Every activated DSI should appear in inventory.

The second is the review discipline. Source attribute reviews require committed time.

The third is the clinician engagement. Training and ongoing use guidance require clinical leadership.

The fourth is the vendor relationship. EHR vendor coordination on DSI changes affects operational stability.

Three Things to Work Through Before the Next Certification Survey

A community hospital COO should work through three things on HTI-1 operations. The first is a DSI inventory refresh that captures all activated interventions. The second is source attribute review discipline with documented evidence. The third is clinician engagement that produces appropriate DSI use.

HTI-1 Operations Go Beyond What the EHR Vendor's Certification Covers

A community hospital COO operating HTI-1 obligations is operating beyond what the EHR vendor's certification covers. The operational cost is moderate.

If your hospital has not assessed HTI-1 operations against the certified EHR in the last twelve months, that is the conversation worth having with your Tech-Operations partner before the next ONC update cycle.

Five Nines Technology Group is a Tech-Operations partner for community hospitals, clinics, and health systems. Translating regulatory frameworks into operating discipline at community hospital scale is where our team focuses.