Karen DeSalvo: In hindsight, we needed common interoperability standards

A common set of standards for the exchange of electronic health information likely could have improved the current state of interoperability in the industry, National Coordinator for Health IT Karen DeSalvo said.

Speaking Wednesday at the eHealth Initiative's iThrive Innovation Challenge in the District of Columbia, DeSalvo (pictured) was asked about what she wishes she or the healthcare industry would have done differently in regard to the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.

"What seems that it would have been helpful is if we had agreed as an ecosystem--the government, the private sector--that we would have a set of common standards that would allow us to have more seamless sharing of basic health information," she said. "We're moving toward that with the industry, but I think what that's created is a complexity and aggregation of data … In hindsight, maybe some more standardization, or a lot more," was necessary.

DeSalvo noted, however, that should not take away from the progress being made on interoperability through both federal and private sector efforts. Sometimes, she said, it's easy to forget HITECH's successes.

"We're all impatient--I know I certainly am," DeSalvo said. "And we want to have that seamless experience where information is available so we can make decisions as people, as public policy scientists, as clinicians, as payers. The digitization of the healthcare experience for Americans has been a dramatic story in the last six years; I think we should take a moment and say 'this is incredible.'"

At another panel at the event later in the day, industry leaders from the CommonWell Health Alliance, the Sequoia Project, Health Level 7 and the Workgroup for Electronic Data Interface weighed in with their own thoughts on interoperability standards. CommonWell Executive Director Jitin Asnaani said building standards does not necessarily equate to interoperability.

"Somebody still has to do the hard work of actually managing the process of operations; of actually transmitting those bits and bytes," Asnaani said.

When asked which group should be designated with setting standards, Asnaani and others agreed that the process should be collaborative.

"Standards are not standards because we say they are; standards are standards because everybody uses them," he said. "A lot of the work that we do within CommonWell, we're sharing. Our specifications are the furthest thing from proprietary; they're up on the Web for everybody to use."

HL7 CEO Charles Jaffe said that in regard to the Fast Healthcare Interoperability Resources (FHIR) framework, regulation was never the intent.

"I don't know where FHIR stands in this, but our relationship with the federal agencies inside the U.S. and outside the U.S. has been one of adoption rather than regulation setting or legislation," Jaffe said. "FDA, NIH, CDC, the National Library of Medicine, the VA, the Department of Defense--they all are contributing to FHIR profiling, but no one has uttered the regulation word and we're pleased if it stays that way."  

Sequoia Project CEO Mariann Yeager added that standards setting is an organic process.

"I don't know that one organization can speak to the needs of an entire industry," she said. "There would be a real benefit to having a process that engages stakeholders in the implementation community and focuses on what use cases are high value, and then figure out how to implement that."

Marc Probst, CIO at Salt Lake City-based Intermountain Healthcare, has been among the most outspoken proponents of setting interoperability standards for health data exchange. At the College of Healthcare Information Management Executives' fall meeting last October, he called standards "the root foundational issue" of interoperability, and said the industry has taken "way too much time" discussing it rather than setting a plan in motion. 

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