HIMSS14: Top-down view of interoperability
ORLANDO–-When it comes to interoperability, “build in incremental steps and don’t let the perfect be the enemy of the good,” said Doug Fridsma, MD, PhD, chief science officer, Office of the National Coordinator for Health IT (ONC), at the Healthcare Information and Management Systems Society's pre-conference Interoperability Symposium.
Interoperability is essential to achieving the ONC’s goal of transforming the industry into a learning health system.
“The goal is to have every interaction with a patient serve as an opportunity to learn about that patient and do a better job,” Fridsma said, noting that it spans from patient to practice to population to public in an exponential manner—with every level informing the other in a feedback loop. “It will take engagement across that continuum to build that learning system."
“Standardization and access to data is critical to unlocking its potential. Data can be used to improve population, public and patient health,” he said.
Fridsma cited five pillars necessary to support interoperability:
- Meaningful adoption of EHRs by all providers.
- Evolving appropriate standards and certification.
- Ensuring privacy and security for data.
- Encouraging appropriate business and clinical incentives.
- Proper governance to support transparent exchange and ongoing access for all patients and providers.
One of the agency’s main goal is supporting the success of Meaningful Use (MU), which he said “is the vehicle to achieve the triple aim” of better healthcare, better health and reduced costs.
MU Stage 1 supports EHR adoption and MU Stage 2 fosters health information exchange, with the MU Stage 3 eventually driving the goal of better outcomes. This framework supports incremental progress toward interoperability.
Getting to interoperability requires not only exchange, but the successful use of data, he said. “If you exchange information in a language or format that the other can’t understand, you really haven’t achieved interoperability. It has to be grounded in what you want to do.”
ONC’s strategy includes expanding the value of the portfolio of standards to support accountable care organizations, payment reform, Department of Defense and Veterans Affairs system acquisitions and other administrative priorities. Also, the agency plans to modernize its standards portfolio to take advantage of newer, simpler and more powerful standards.
This standards portfolio encompasses standardized meanings through vocabulary and terminologies; standardized structure through context specifications and format; standardized transport; standardized security; and standardized services.
In the area of harmonizing terminologies, he said in an interoperable system,: “If I say congestive heart failure and you say dropsy, because you’re old, we can understand each other.” He urged for a move from declarative semantics to computable semantics.
In standardized transport, Fridsma said the agency is working to move from complex orchestration to simple restful approaches.
“We must continue to refine the standards that we have, and add to the portfolio based on new use cases and initiatives, and move from the current approach to new and more modern and powerful methods to achieve interoperability,” he said.
The Structured Data Capture Initiative and the Data Access Framework are essential steps the agency is pursuing to achieve interoperability. The data capture effort, launched in January 2013, looks at ways of using EHRs to collect data for quality improvement and research, he said. “It’s broad and powerful technology that, if we get it right, provides tremendous flexibility on how to capture and use this information.”
Central to ONC's standards work is the Standards & Interoperability Framework, a consensus-building online platform to harmonize vocabulary, content, structure, services and security.
Fridsma reported strong participation in the S&I Framework, with 2,100 meetings since it was launched three years ago. So far, it has seen 5,000 ballot comments on standards, with nearly 4,000 resolved, he said.
Engaging and working with standards development organizations will be essential for assembling standards “building blocks” to solve problems, he said.
To that end, Joyce Sensmeier, vice president of informatics for HIMSS and president of IHE, reported progress on IHE’s national and international work to develop consensus-based technical frameworks and integration profiles, vet them through the ISO process, and make them available in the public domain.
IHE’s international organization includes 650 organizations and vendors that are actively testing systems for better information exchange.
With interoperability “top of mind” for legislators, the healthcare industry and patients, “we are truly making tremendous progress,” she said.