health it summit austin 2013 - case study "enabling data interoperability through the...
TRANSCRIPT
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Enabling Interoperability
Charles Jaffe, MD, PhD CEO, Health Level 7
Professor of Medicine, UCSD
iHT2 HIT Summit
Austin
11December 2013
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CME Disclaimer:
I don’t sell anything. Almost anything
you may want from me
is free.
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Why would the conference producers
place a presentation
on standards
right before lunch?
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Best Guess:
Because HL7 standards are the
cornerstone of
Meaningful Use 2
and will be even more critical in
Meaningful Use 3.
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Next Best Guess:
Because HL7 standards are the
only real hope of ever
achieving Interoperability.
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Why is Interoperability so hard?
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I guess it depends upon what
you mean by
Interoperability.
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Semantic Interoperability means
the ability of two machines to
exchange data,
and
to reuse the data that has
been exchanged.
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There are other kinds of
Interoperability,
but if you want to get to
Plug-and-Play Interoperability
then it’s even harder.
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“All you need in this life is
ignorance and confidence,
and then success is sure.”
Mark Twain
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Reasons why Plug-and-Play
Interoperability is so difficult:
Too many standards.
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Too many standards.
The last time I’m certain that
the US got it right was 1861.
The government mandated
one gauge of track for the
Continental Railroad.
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Too many standards.
The Australian rail system
has 3 gauges of track.
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Catherine Aird
“If you can't be a good
example, then you'll just have
to serve as a
horrible warning.”
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Too many standards.
Electric plugs.
Is any further explanation needed?
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Too many competing standards.
Genomics
The rule of Not Invented Here
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Reasons why Plug-and-Play
Interoperability is so difficult:
Too few standards.
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“Knowledge is knowing that a
tomato is a fruit.
Wisdom is not putting
tomatoes in a fruit salad.”
Peter Kay
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Standards too difficult to
understand,
apply,
manage, or
implement
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Healthcare is difficult.
Data Elements needed for an
ATM: 10
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Healthcare is difficult.
Unique English words:
450,000*
* I would not like to debate the exact figure.
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Healthcare is difficult.
Unique terms in the
National Library of Medicine
Metathesaurus:
2.4 Million
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(Sometimes) Government
Regulatory Agencies
make things more difficult
than necessary.
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What is this?
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European Commission Regulation No. 1677/88:
bananas are allowed a bend of 10mm per 10cm of length
European Commission Regulation No. 2257/94:
bananas must be "free from malformation or abnormal
curvature“
Sorry, EC Regulation says this is
not a banana.
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“If the Federal Government
were put in charge of the
Sahara Desert,
in five years we would
run out of sand.”
Milton Friedman
American Economist
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Some standards are
too flexible.
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Too flexible:
HL7 Version 2
dreaded Z-segment.
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One solution: Postel’s Principle
Send conservatively.
Receive liberally.
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Some standards are
not flexible enough.
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Not flexible:
The list is too long.
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Benjamin Disraeli
“How much easier it is to be
critical than correct.”
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Some standards are
difficult (impossible)
for humans to use.
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Hard for humans to use:
ICD-10
Impossible for humans to use:
ICD-11
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Some standards are
interpreted
differently by different folks.
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HTML 4
How many web browsers do you
need to use?
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Some standards are
implemented
differently by different folks.
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Same answer.*
* Each web site has a different idea what
HTML 4 requires.
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Ashleigh Brilliant
“To be sure of hitting the target,
shoot first, and call whatever
you hit the target.”
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Well, what does HL7
actually do?
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HL7 doesn't
write software.
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We make
writing software
more intuitive.
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HL7 doesn't provide
care for patients.
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We make caring
for patients
safer.
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HL7 doesn't
do clinical research.
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We make
doing clinical research
more effective.
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HL7 doesn't
pay for healthcare.
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We make
paying for healthcare
less costly.
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HL7
is developing standards that
will change the way we
exchange,
analyze,
and reuse
healthcare data.
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Here are
3
of them.
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CDA: Clinical
Document Architecture
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Think of CDA as an envelope
in which you can put any document,
like a report or EKG or image.
Mayo Clinic
Department of Immunology
200 1st St SW
Rochester, MN 55905
Charles Jaffe, MD
Department of Medicine
University of California
La Jolla, CA 92037
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• Securely identified
• Unaltered document formatting
• Machine processable
• Human readable
• Combined structured data & free text
• Easily mined for complex data signals
• Scalable for both text & large image files
Characteristics of CDA Documents
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The very modular nature
of CDA makes interoperability
faster,
easier,
and cheaper.
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Consolidated-CDA
is the keystone to bridging
from MU 2 to MU3
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• Public Health reporting
• Clinical Decision Support
• Regulatory submissions for Clinical Trials
• Quality Measures
• ePrescribing
• Personal Health Records
• Procedure reports & Operative notes
Some Current Applications of CDA
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New releases of
CDA
will fundamentally
change
how documents
are exchanged
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For terabyte instances of
big data analytics,
CDA has proven both scalable & reliable
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A portfolio of tools
for storage, curation, retrieval, archiving
and creation of templates for CDA,
built with a unique
template exchange language.
Trifolia
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FHIR
Fast Healthcare Interoperability
Resources
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FHIR
A framework for the development of
data exchange technology that offers
the interoperability of the RIM, while
hiding the complexity of V3
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FHIR
What makes FHIR fast?
Faster to learn
Faster to develop
Faster to implement
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A gentle word of caution about FHIR
Current Status
2015-2016
The
Gartner
Hype
Cycle
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FHIR Enables
Mobile Health
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CommonWell
Embraces
FHIR
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BRIDG
Model
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BRIDG Model
• Biomedical Research Integrated
Domain Group
• A domain analysis model of the
HL7 RIM
• Seamlessly integrates patient care
and clinical research data
• Integrates with regulatory submission
processes
• Supports the Learning Health System
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HL7
is more than
standards
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HL7
is about
implementation
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If it couldn’t get any more
overwhelming,
I’ll try to describe
15 new Implementation Programs
in the next 5 minutes.*
* No, you don’t have to take notes.
I’ll give you these slides.
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Help Desk
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HL7 User
Groups
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International Healthcare IT Policy
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Health
Professionals
Group
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EMR
Functional
Model
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Longitudinal
PHR
Functional
Model
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Blue Button
Veterans Administration
HL7
Blue Cross
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Mobile Health
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Privacy
& Security
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Claims &
Claims Attachments
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Genomics
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Healthcare Quality
Measures
& Reporting
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Conformance Testing
& Certification
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• ISO 17025 Testing & Certification partners
• Iterative, not once-and-done
• Not a Connectathon model
• Asynchronous – 7/24
• Process improvement focused
Conformance Testing
& Certification
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Education Services
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HL7 Education Portal
• eLearning Program
• HL7 Competency Certification
• Webinar series
• Education Summits
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Vocabulary
Authority
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If you haven’t had enough
Interoperability
for one morning, try…
www.HL7.org