Interoperability may rest on reduced optionality

Mary Stevens, Editor, CMIO magazine

Transitions of care, notorious as points of communication failure, are the target of a federal interoperability effort, said Doug Fridsma, MD, PhD, director of the Office of Interoperability and Standards at the Office of the National Coordinator for Health IT (ONC), during a webinar earlier this week.

The appropriately named Transitions of Care project was launched in January, with the goal of supporting quality goals and meaningful use Stage 1 and likely Stage 2 requirements through standardized, clinically meaningful core data, he said.

A question following the presentation illustrates the importance of this work; Fridsma’s answer gives an idea of the time and effort necessary to make it happen.

Q: There are a lot of specifications for each type of document and not all specifications match for the same document (for example, C32 vs. C62). Is there any one source of information that takes priority over other sources?

A: This is one of the reasons the Transitions of Care project was started. Many specifications have different elements that can be included, but many of them have been considered optional. If things are optional, you’re not sure whether they were forgotten or purposely left out. If you’re expecting information but it’s not there, it’s hard to know exactly how you can achieve interoperability with regard to vocabularies and terminology.

We are hoping the Transitions of Care Project can help us at least clarify how some of these transitions can be supported, and will provide a way of getting a more uniform set of implementation specifications around how information can be exchanged to support that.

The Health IT Standards Panel (HITSP) has done tremendous work in trying to articulate all the different kinds of standards and specifications we might need. Many of those have been used in Nationwide Health Information Network specs in first pilot; some have flowed over into the Direct Project as well.

Part of modular specification work is to just go through those things and identify the ones that we think need to be brought forward in terms of a national standard and then devote some time and energy to make sure we’ve got those locked down, we’ve tested them and we know that they work.

The S&I framework is a continuation of the HITSP work in a much more focused way. It’s not just about coming up with specifications, but in fact creating “reduced optionality,” if you will, and trying to drive toward interoperability, test those and pilot them in the real world to make sure they work.

What is your organization doing to streamline transitions of care and avoid communication failures? Let me know at mstevens@trimedmedia.com.

Mary Stevens, Editor