HCI-DC 2014: Standards and interoperability

“There is definitely a sense of expectation. We need to move things forward with interoperability,” said David Cassel, senior interoperability engineer for Epic Systems, speaking at the Health Care Innovation Day, a joint event hosted by the Office of the National Coordinator for Health IT and the West Health Institute.

Cassel compared healthcare to the local phone company that recently dug up lawns in his neighborhood to lay new cables and build an infrastructure for new services. “That’s the point we’re at right now. Meaningful Use has done a great job in terms of spurring some activity on the interoperability front.” The infrastructure investment is being made and it’s “time to start seeing the investment start paying off.”

Interoperability would “free up development interfaces for real innovation instead of custom interfacing,” he added.

The way information is moved back and forth is secondary, Cassel said. The goal is to provide information in ways that ultimately improves healthcare. “When used properly, technical standards will enable greater innovation by freeing up development resources.”

While there’s value in having a quality bar that everyone must meet, Cassel said, “we need to be mindful of the impact of regulation. There’s a balance somewhere and we need to try and strike that.”

It’s tempting to change regulations, Cassel said. There are three types of changes made to standards and each has a different impact. Evolution or clarification of existing standards could expand a profile. “That type of change  does not have a significant development impact.” Another change is the addition of a new specification within an existing technical architecture. A new service could bring a huge amount of data to bear. A third type is a shift to a completely new technical approach. In this event, “you need to be careful. It doesn’t mean you shouldn’t do that every now and again but do it judiciously.” Developers can be tempted by cool new technologies but healthcare needs to keep the goal of patient care in mind.

“Interoperability standards are just a means to an end. Change is not in itself innovation,” he said. Cassel also warned that a lot of great work going on in the interoperability space needs to be protected. “We need to make sure we’re not devaluing the investments already made.”

 “We see the future of innovation and interoperability as around the EHR becoming a platform against which innovative instances and services can be deployed,” said David McCallie, senior vice president of medical informatics for Cerner and director of the Cerner Medical Informatics Institute. The platform aspect is the recordkeeping, workflow, compliance and other “boring stuff you have to have.  Innovation occurs around the edges.” He said Cerner has an edge development team and MPage that is in the process of becoming an open framework.

McCallie referred to FHIR—fast healthcare interoperability resources—a set of resources that represent granular clinical concepts. This open standard is “rethinking the core way we move data around the enterprise. It’s extremely well done and I predict we’ll see widespread industry uptake at a pace we didn’t see with HL7 version 3 that was overly complicated.”

“Semantic inferencing is extremely hard,” he said. Industry consensus on FHIR would achieve a new kind of interoperability “which we think will open the floodgate of innovation.”