appropriate data sets for specific use cases
and ensure that the same data is represented the same way across these data sets. Our
national strategy philosophically should be
to align data formats (like CDA and HL7
messages) with the use cases they support
based on a common data definition rather
than a single common data set that satis-fies no particular use case well. The notion
of CDA and IHE profiles is that general-purpose data formats should be tailored to
specific uses based on a common foundation. Let’s agree on the common foundation (whether it’s the HL7 RIM or FHIR
resources) and leave it to the SDOs to define
the specifics.
Monetization of data. Some EHR vendors are putting up financial barriers to
access data that comes into the EHR even if
the data originates within an organization –
often referred to as “information blocking.”
While the use by vendors of standards-based versus proprietary approaches to
data access helps reduce some of these barriers, the strict use of standards by vendors
does not guarantee that data will be accessible and available to the organizations that
have already paid to capture and store it.
Some folks just don’t get it. Or do
they? I have seen push-back from consum-er-oriented groups on the whole notion of
health data interoperability usually citing
some unfavorably perceived characteristic
of the Affordable Care Act or worry that
this is all a nefarious plot to turn EHRs into
public utilities that will allow the government to control information and invade our
privacy. I can’t take seriously attitudes that
completely misunderstand or misinterpret
what is written in documents and plans. On
the other hand, the world described in the
LHS is so rich with data that I can understand this interpretation and am sobered
by it.
Consent law differences are a bug to
some, a feature to others. We continue to
be unable to reconcile state and local con-
sent-to-share data laws across the country
which many consider to be a major barrier
to interoperability. But to some, our attempt
to harmonize and reduce state policy differ-
ences in this area is an attempt to squelch
states’ rights and is offensive to them. And
attempts to reinterpret HIPAA without
actually changing it are unproductive and
confusing.
Governance. Still. We continue to
struggle with the role of government versus the market in the governance of health
IT and interoperability in particular. Some
feel the Federal government is ignoring
the community activities already under-way and advocate for a very light layer of
government coordination and no more. Or
worse, some fear that current initiatives
are viewed by others in the ecosystem as a
“problem to be solved” and not opportunities to be leveraged and resent the characterization. But will improved governance
solve the basic issue of new standards being
layered on old standards versus replacing
them? Will it solve any of the intractable
questions without leaving sizable minority opinions dissatisfied? Can it overcome
inherent inconsistencies in State law?
Should we just let the SDOs do their work
and stay out of the way?
I’ve raised many issues here, and perhaps solved few of them. I don’t pretend
these problems can be solved overnight.
But we must as a nation (is that even possible?) make some decisions about how we
will approach solving these issues. I propose we begin by
■ n Being skeptical of the notion of
“consensus.” The best strategy might not
be the most popular strategy. Some problems are in fact intractable. One critical role
of leadership is to provide direction when
the best choice is not obvious.
■ n Leveraging the past with an eye to
the future. Enough of us have been around
long enough to remember the successes
and failures of past initiatives. We are at an
inflection point: we must consider
everything that has taken place up to this point
before we charge on ahead.
■ n Recognizing that this is more about
the pace of change than the substance
of change. Our healthcare ecosystem is
too large, complex, and fragmented to move
lock-step. We need a broad vision within
which early adopters, mainstream imple-
menters, and laggards can all see a path
forward. The details need to be tailored to
each phase of implementation.
■ n In the meantime, focus on seman-
tics. If we did nothing else over the next few
years other than ensure that data in our
various systems use standards terminolo-
gies and code sets, we will be far ahead of
the curve when we are ready to really make
interoperability happen. JHIM
INTEROPERABILITY: THE INTEROPERABILITY OF THINGS
REFERENCES
1.
http://www.healthit.gov/policy-researchers-implementers/interoperability
2. https://www.hln.com/assets/pdf/Coming-to-
Terms-February-2007.pdf
3. The saddest comment of all on this is that
the wiki for the American Health Information
Community (AHIC) is inaccessible due to an
“expired subscription.”
