HITPC: 5 elements of ONC's interoperability strategy

For interoperability standards to be successful, “we have to build incrementally,” said Doug Fridsma, MD, PhD, chief science officer for the Office of the National Coordinator for Health IT (ONC). “The systems we install today are the legacy systems of tomorrow. We need resilient ways to make sure standards support what we have now and in the future.”

The problems healthcare has aren’t going to be solved in a short period of time, he added, speaking during the Feb. 4 Health IT Policy Committee.

Fridsma discussed five elements ONC is trying to standardize.

Meaning: This includes vocabularies and content. He said syntax enables exchange and meaning enables various stakeholders to use information.

Structure: ONC is continuing to refine the consolidated CDA, he said, and track the challenges people have. “We can’t get to interoperability through committee” but through experience and captured information. That information goes back to standards development organizations to make sure everyone is on the same page. That also will help ONC determine where and how to expand its portfolio, he said. “We also have to recognize that as more and more data gets out there, we need to think about how to move from document-centric views to data-centric views.”

Fridsma also said that conversations about which data to structure are needed. “We’re not going to structure everything. Just because we can structure doesn’t mean we should.”

Transport: “We need to make sure Direct implementation is successful,” said Fridsma. “It’s important to recognize that culture will always trump strategy. We have to be sensitive and make sure we look at that.” Like other industries, he said healthcare needs to move from “complex orchestration to things that provide simple, restful approaches.”

Security: Healthcare needs a knowledge-based way to authenticate patients, Fridsma said. Other industries are moving from an infrastructure based on security certificates to a more federated approach. Fridsma anticipates modular policies that match the modular technology in use.

Services: “Ultimately, we want to move from interoperability based on what we build to how to use it,” he said. In other words, queries in a certain format going to this specific server will produce data in this particular format and “hides a lot of complexity and enables people to more quickly connect the dots.”

We have to tie to the levers we have and make sure we continue to refine testing tools, he said. “Some we got right and some we didn’t. We’re working to see how we can provide extra testing, demonstration … to get to interoperability and test for interoperability, not just conformance to the standards.”

ONC also is trying to use a “broader set of ways in which we can look at problems we’re trying to solve to make sure we don’t create silos,” he said.

The office has to bear in mind that technology is not static. “We need a resilient portfolio that allows us to move incrementally toward newer, simpler, more powerful standards.”

The strategy for standards depends on the priorities of the Health IT Policy Committee, he said. Then, they can move forward and expand or refine standards. “We want to create ways of moving from declarative, static lists to ways that we can create computable ways of representing terms and concepts.”