Standards alone are not sufficient to achieve interoperability, according to David McCallie, M.D., senior vice president of medical informatics for Cerner.
McCallie, who also has served as a member of the Health IT Standards Committee since its beginnings in 2009, warns against the notion that nothing has been achieved in a guest post on the blog of Beth Israel Deaconess Medical Center CIO John Halamka.
"In particular, we have mostly settled the vocabulary questions for encoding the record," McCallie says. "We have widely deployed a good e-prescribing standard. We have established a standard for secure email that will eventually replace the fax machine, and we have widely [but not yet universally] deployed a good standard for document-centric query exchange."
At the same time, he cautions against congressional "fixes" that assume that once standards are in place, interoperability will inevitably follow.
To that end, he cites seven conditions required for interoperability. According to McCallie:
- A business process must exist for which standardization is needed
- A proven standard then needs to be developed, via an iterative process that involves repeated real-world testing and validation
- A group of healthcare entities must choose to deploy and use the standard, in service of some business purpose
- A "network architecture" must be defined that provides for the identity, trust and security frameworks necessary for data sharing in the complex world of healthcare
- A "business architecture" must exist that manages the contractual and legal arrangements necessary for healthcare data sharing to occur
- A governance mechanism with sufficient authority over the participants must ensure that the network and business frameworks are followed
- All of the ancillary infrastructure (such as directory services, certificate authorities, and certification tests) must be organized and deployed in support of the standard
The JASON Task Force, which McCallie co-chaired, summed up these requirements into Data Sharing Arrangements, which do not just happen, but require the active engagement and collaboration of the various stakeholders in order to enable real-world, widespread use, he says. The JASON Task Force is an independent group of scientists that advises the government on science and technology.
The task force previously reported that "meaningful interoperability" had not been achieved through Meaningful Use Stage 1 or 2; it later recommended that Stage 3 requirements be narrowed to more closely focus on interoperability.
Interoperability also was one of the main topics of discussion during a Senate Committee on Health, Education, Labor and Pensions hearing Wednesday. It was one in a series the committee set up to seek ways to improve electronic health record exchange and interoperability of health IT systems.
To learn more:
- read the blog post