Interoperability Doug Fridsma, MD PhD President & CEO, AMIA
Getting to Interoperability • To get to interoperability (or to avoid information blocking) we need a common understanding of the problem • Can’t solve the problem all at once • Need to break it into pieces that allow different groups to work on different parts of the problem • How we frame the problem will affect the solution(s) we get • Ultra-large scale system • Definition of Interoperability AMIA PowerPoint Template 2
It’s not architecture, it’s city planning Ultra-Large-Scale Systems The Software Challenge of the Future
It’s not architecture. It’s city planning
Interoperability only makes sense in the context of what you want to DO Interoperability (IEEE) • Ability of two or more systems to exchange information • Ability of those systems to use the information that has been exchanged
Care summary Clinical Trial Eligibility Public Health Reporting Public Health Reporting Transitions of Care “Silos of Interoperability” • Define Interoperability in terms of the ”thing you want to do” • Without coordination across there is no shared “building blocks” • This creates confusion • Quality measures • Data Registries • Clinical Decision Support • EHRs • Non-health data • etc
You need a framework to pull together the different use cases “You can’t build a skyscraper by nailing 10,000 dog houses together” 8
Think HORIZONTALLY rather than vertically Consumer Big Data and population Clinical and Electronic Health health empowerment Record and Translational Quality Research Patient Practice Population Public Informatics, standards, testing, business drivers, governance
Information Blocking and the Socio-Technical Stack Public Policy Legal Responsibilities (e.g. HIPAA, 42 CFR Part 2) Policy and Intellectual Property Contractual Decisions (e.g. Epic App Orchard) Business drivers Business Drivers Market-based Motivations (e.g. ACOs) Workflow (dynamic) When to apply the data (e.g. lab test results) Implementation Context (static) How to apply the data (e.g. Admission v. Discharge Summary) Services Purpose-specific APIs and services that leverage the other four layers API Semantic Terminologies, Structured data, coded (e.g. ICD-10, SNOMED) Syntactic Message formatting (e.g. CCDA v2) Traditional technology Transport How the message move from A to B stack Security How we ensure that messages are secure and private
Information Blocking and the Socio-Technical Stack Public Policy Legal Responsibilities (e.g. HIPAA, 42 CFR Part 2) Policy and Intellectual Property Contractual Decisions (e.g. Epic App Orchard) Business drivers Business Drivers Market-based Motivations (e.g. ACOs) Workflow (dynamic) When to apply the data (e.g. lab test results) Implementation Context (static) How to apply the data (e.g. Admission v. Discharge Summary) Services Purpose-specific APIs and services that leverage the other four layers API Semantic Terminologies, Structured data, coded (e.g. ICD-10, SNOMED) Syntactic Message formatting (e.g. CCDA v2) Traditional technology Transport How the message move from A to B stack Security How we ensure that messages are secure and private
Information Blocking and the Socio-Technical Stack Public Policy Legal Responsibilities (e.g. HIPAA, 42 CFR Part 2) Policy and Intellectual Property Contractual Decisions (e.g. Epic App Orchard) Business drivers Business Drivers Market-based Motivations (e.g. ACOs) Workflow (dynamic) When to apply the data (e.g. lab test results) Implementation Context (static) How to apply the data (e.g. Admission v. Discharge Summary) Services Purpose-specific APIs and services that leverage the other four layers API Semantic Terminologies, Structured data, coded (e.g. ICD-10, SNOMED) Syntactic Message formatting (e.g. CCDA v2) Traditional technology Transport How the message move from A to B stack Security How we ensure that messages are secure and private
Information Blocking and the Socio-Technical Stack Public Policy Legal Responsibilities (e.g. HIPAA, 42 CFR Part 2) Policy and Intellectual Property Contractual Decisions (e.g. Epic App Orchard) Business drivers Business Drivers Market-based Motivations (e.g. ACOs) Workflow (dynamic) When to apply the data (e.g. lab test results) Implementation Context (static) How to apply the data (e.g. Admission v. Discharge Summary) Services Purpose-specific APIs and services that leverage the other four layers API Semantic Terminologies, Structured data, coded (e.g. ICD-10, SNOMED) Syntactic Message formatting (e.g. CCDA v2) Traditional technology Transport How the message move from A to B stack Security How we ensure that messages are secure and private
Care summary Clinical Trial Eligibility Public Health Reporting Public Health Reporting Transitions of Care Information Blocking and the Socio- Technical Stack Public Policy Legal Responsibilities (e.g. HIPAA, 42 CFR Part 2) Policy and Intellectual Property Contractual Decisions (e.g. Epic App Orchard) Business drivers Business Drivers Market-based Motivations (e.g. ACOs) Workflow (dynamic) When to apply the data (e.g. lab test results) Implementation Context (static) How to apply the data (e.g. Admission v. Discharge Summary) Services Purpose-specific APIs and services that leverage the other four layers API Semantic Terminologies, Structured data, coded (e.g. ICD-10, SNOMED) Syntactic Message formatting (e.g. CCDA v2) Traditional technology Transport How the message move from A to B stack Security How we ensure that messages are secure and private
SO HOW DO WE GET THERE? AMIA PowerPoint Template 15
THE PATH OF LEAST REGRET: THREE THINGS WE NEED
BUILD DOCUMENTS FROM DATA, NOT THE OTHER WAY AROUND
What is needed: A common format for granular data • Common data formats for • Text data • Categorical data • Numerical data • More… • This is the beginning of the “horizontal coordination” across different use cases • Quality Measures • Clinical Decision Support • Registries
FULL EXPORT OF THE PATIENT RECORD (AND NARRATIVE)
Restore the importance of the narrative and unstructured text Patients are more than a collection of discrete data • Disease vs. illness • The importance of the narrative to understanding patients The unstructured data is where discoveries are made • Precision medicine Restore the balance of power for access to data • Empower patients, researchers, public health officers
TEST BOTH SIDES OF EXCHANGE
Postel’s principle When you send, conform to the standard • Pick a set of options and make sure it conforms to a valid instance of the standard When you receive, accept ANY version that conforms to the standard • Any variation that is valid Create the conditions of interoperability when you create the standard, rather than when you implement it
Doug Fridsma MD PhD AMIA @AMIAinformatics THANK YOU! Official Group of AMIA AMIA informatics Fridsma@amia.org www.amia.org #WhyInformatics 23
AMIA is the professional home for more than AMIA 5,400 informatics professionals, representing @AMIAinformatics frontline clinicians, researchers, public health experts and educators who bring meaning to Official Group of AMIA data, manage information and generate new AMIA informatics knowledge across the research and healthcare enterprise. www.amia.org #WhyInformatics AMIA 2017 | amia.org 24
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