Leonard Kish, Principal at VivaPhi, sat down with Ed Park, COO of athenaHealth, to discuss how interoperability is defined, and how it might be accelerating faster than we think.
LK: Ed, how do you define interoperability?
EP: Interoperability is the ability for different systems to exchange information and then use that information in a way that is helpful to the users. It’s not simply just the movement of data, it’s the useful movement of it to achieve some sort of goal that the end user can use and understand and digest.
LK: So do you have measures of interoperability you use?
EP: The way we think about interoperability is in three major tiers. The first strata (1) for interoperability can be defined by the standard HL7 definitions that have been around for the better part of three decades at this point. Those are the standard pipes that are being built all the time. So lab interoperability, prescription interoperability, hospital discharge summary interoperability. Those sort of basic sort of notes that are encapsulated in HL7. The second tier (2) of interoperability we are thinking about is the semantic interoperability that has been enabled by meaningful use. The most useful thing that meaningful use did from an interop standpoint was to standardize all the data dictionaries. And by that I mean that they standardized the medication data dictionary, the immunizations, allergies and problems.
There has been much enthusiasm in the health IT industry regarding the health data standard that HL7 International is working on, HL7 FHIR, which is now a DSTU (draft standard for trial use). Everyone involved with health data – EHR vendors, interoperability vendors, medical app developers, “big data” proponents and hospital CIOs, to name a few – have high hopes that FHIR can be the golden ticket that leads to true health care interoperability.
Most of the enthusiasm is around the technologies being utilized in the standard including RESTful web services, JSON encoding, and granular data content called resources.
Technology-Empowered FHIR Data
RESTful web services, in particular, is a technology that has been strongly embraced by other industries and has the potential to be leveraged for engaging patients by connecting mobile technologies with their provider’s EHR system. This advancement represents a huge step toward building a patient-centered health care system.
Over the last decade, the healthcare industry has utilized SOAP-based web services to transfer documents. Most programmers today, if given their choice, would likely lean towards RESTful web services, preferably with data encoded in the JSON format. It is a better choice for mobile applications independent of whether the client device technology is iOS, Android, Windows, or even Mobile Web. Most social media sites today, such as Twitter and Facebook, publish RESTful APIs for connectivity.
This preference towards RESTful web services is based on some of the advantages that REST has over SOAP:
Regardless of the U.S. administration’s “meaningful use” requirements, if health information technology (HIT) is to become meaningful for patients, it must include the prescription of information and tools to help each patient better manage his or her own care.
Ask patients what they want from HIT systems, and they will tell you three things:
– “Tell me my diagnosis, what will happen, and what I can do myself to better manage the problem.”
– “Tell me my medical tests results and what they mean to me.”
– “Tell me my treatment options, and help me participate in the treatment decisions.”
The soon-to-be-finalized HL7 International Context-Aware Information Retrieval standard (nicknamed the HL7 “Infobutton” standard) makes it far easier for providers of electronic health records (EHRs) and personal health records (PHRs) to deliver just what the patient wants. And that is what will put the meaning into meaningful.
Using the HL7 Infobutton Standard for Information Prescriptions
The HL7 Infobutton standard has been widely adopted since 2007. It facilitates the delivery of a set of standardized information about the patient, the provider, and the activity of a specific care encounter or moment in care. An Infobutton manager (or equivalent) accessed by an EHR application can then pull from that set the information it needs for any relevant use case. In most cases the Infobutton has been used to bring up decision support information for the clinician.