Wednesday, April 02, 2014

HIMSS14 and the Culture of Interoperability

Interesting follow up piece to HIMSS14 from Deloitte in WSJ, and a few thoughts on human and machine interoperability. The message:

Interoperability standards are often overemphasized in discussions of data sharing, and it is important to understand that standards for interoperability already exist and can be implemented. What is critical is shedding the light on building interoperability into vendor design of medical products versus just building standards. Enlisting provider buy-in is one way of supporting this goal.
We have the standards, now we need to apply them. For modern interoperability standards like HL7 CDA, for instance, the barrier to entry is incredibly low – you can wrap an existing PDF in an appropriate header, which is essentially boilerplate, and you have satisfied the lowest level of CDA compliance. What is important to understand here is that “clinical interoperability” does not have to imply “machine-readable” except in the broad sense of syntactically capable of exchange between two systems or components. The lowest level of interoperability is exchange of human-readable content within a structure that can later be extended to support machine-readable coding. 

From the HL7 Standards blog:

The primary characteristic of a CDA document is that it must be readable by humans. The CDA specification states that, “human readability guarantees that a receiver of a CDA document can algorithmically display the clinical content of the note on a standard Web browser.” This requirement means that a clinician or patient can take a CDA document and display it on any computer with a web browser without the need to load any additional application.

The real work in interoperability, as we know, is in rationalizing and aligning code-sets. That's a governance issue. Exposing human-readable content in a structured fashion is important, as described above. But is it possible to access a system's supported vocabulary  and conformance profile using a standard Web browser? Maybe that would be useful as well. Incidentally, that's one of the ways FHIR goes beyond CDA. Clinical interoperability is about exchanging a specific type of information, for instance, exchanging clinical information about a patient that allows an exchange partner to leverage what we already know about them. One of the things we should be able to exchange is a conformance profile that defines how such an exchange can take place.

This is at the heart of an ongoing debate in Canada about the future of both CDA and SNOMED-CT. We have existing standards and terminology sets, so aren't these adequate to the task? What can we learn from this debate about what factors contribute to the success or failure of clinical interoperability projects? How can we reduce complexity, while increasing availability of information and metadata?