Tuesday, January 26, 2016

Innovating Interoperability: Getting the future right!

This is the final installment of a series focused on interoperability, a key to continuing the momentum started by the Meaningful Use program, highlighted in “2016 HIT Trends: Consensus Predictions.”
A number of technologies and trends will guide the way interoperability evolves over the next several years. These are detailed in the Office of the National Coordinator's 10 year plan for interoperability in the US, which provides a set of interoperability goals for the next decade and a blueprint for reaching them that encompasses standards, policies, technologies, and market forces.
There's quite a lot of content in the 77 page report, so this article will focus on just three aspects that are relevant to the consensus predictions for 2016 summarized earlier.
1. Learning Health System 
The overarching aim of the interoperability roadmap is to create a Learning Health System (LHS). A learning health system is briefly described as one in which encounter data is collected and analyzed to gain new insights about diseases and treatments. The insights are rapidly turned into best practices, advancing the state of the art and improving future patient encounters.
This is, of course, how the practice of medicine has evolved throughout its history. The important difference with a LHS is that enabling technologies accelerate the cycle time. The LHS relies on data flowing from healthcare facilities to research institutions, public health departments, and payers, so interoperability is a fundamental prerequisite.
2. Fast Healthcare Interoperability Resources (FHIR)
Featured prominently in the ONC’s roadmap, but less so in the 2016 predictions by industry publications, is a new technology called Fast Healthcare Interoperability Resources (FHIR).
Of the 81 predictions gathered from 10 articles about trends and predictions for 2016, only two mentioned FHIR. Chilmark predicted that APIs would gain momentum, but FHIR would not yet catch on. John Halamka, MD, in Healthcare IT News, predicted that a new breed of apps would use FHIR APIs to add a new layer of functionality on top of transactional systems.
The technical details behind FHIR are discussed in this presentation, but the non-technical aspects are what make it truly unique. First, FHIR leverages well-adopted technologies, such as REST, JSON, XML, and OAUTH2. This means that developers don't have to learn and implement new things to facilitate healthcare interoperability. Second, FHIR strikes a compromise between HL7 2.x's granular, real-time messages and CDA's compendious XML document architecture. FHIR resources are just the right size for business applications. Third, because of the first two points, FHIR is gaining broad praise and acceptance by developers. The impact of an enthusiastic developer community can not be overestimated. A long and growing list of vendors has formally expressed interest in FHIR, and there are other organizations besides these working with FHIR.
3. Interoperability Measurement
The ONC's plan calls for measuring the current level of interoperability with an eye toward improving the metrics over time. The private sector has begun to define what successful interoperability looks like. KLAS Research held a summit of 12 large EMR vendors that resulted in agreement on a method for measuring interoperability and will begin publishing its measurements as a way to inform the market about how vendors are performing.
While the ONC’s roadmap contains a number of ambitious objectives, the early success of FHIR and steps toward quantifying interoperability are building momentum toward a Learning Health System.

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