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?
