Hospital CIOs share experiences, issues with interoperability

Although most healthcare chief information officers have implemented certified electronic health record systems and the required standards, many remain frustrated in their quest for interoperability, according to Beth Israel Deaconess Medical Center CIO John Halamka.

In a recent blog post, Halamka, from his conversations with healthcare CIOs around the country, shared several issues, including:

  • HL7 2.x messaging is fine for lab and public health reporting, but there remains a need to specify a single transport mechanism for all public health agencies
  • Consolidated Clinical Document Architecture works well for generating transitions of care documents, but merging that with EHRs remains difficult. Those documents can be more than 50 pages, so there needs to be a way to include only the most relevant data
  • Implementing Direct still provides plenty of challenges, including certificate and trust issues. Medical devices use myriad transmission protocols, so getting that data over Direct isn't easy. And sending datasets larger than 10 megabytes can be a struggle

Halamka, who also serves on FierceHealthIT's Editorial Advisory Board, calls Fast Healthcare Interoperability Resources (FHIR), for many use cases, the "best hope for the future." FHIR is a set of resources and accompanying profiles that enables query/response of the discrete data elements in granular clinical concepts. The goal is for each EHR to provide this capability through a standardized interface that can used in separate modules or "bolt-on" applications, he says.

Twelve organizations--including Epic, Cerner, Mayo Clinic and athenahealth--have joined the Argonaut Project, led by Health Level Seven International (HL-7) to develop FHIR-based API and Core Data Services specifications. The project addresses the recommendations of the Health IT Standards and Policy Committees' joint JASON task force.   

That task force in October recommended Meaningful Use Stage 3 requirements be narrowed to more closely focus on interoperability. It stressed a need to create a unifying software architecture using application programming interfaces.

To learn more:
- read the blog post

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