Hurdles and Solutions for the Interoperable EHR

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Hurdles and Solutions for the Interoperable EHR

• John W, Loonsk, MD FACMI
• Chief Medical Officer CGI

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• Interoperability

• Issues with the availability of definitive and
  detailed standards
• Standards are necessary, but not sufficient for
  interoperability
• Best way to advance standards is to have many
  people using them
• Other challenges to interoperability
• Few incentives for exchanging information
• When value of exchanging is high it costs to
  not be interoperable
• Many incentives for not exchanging information
• Propriety business needs
• Tacit ownership
• Integration services profits
• Existing non standards-based systems
• Patient confidentiality issues
• HIPAA and other legal angst
• Subpoena concerns

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Types of Standards

• Data standards
• Text and viewing
• Terminologies and value sets
• Metadata and XML bins
• Technical standards
• Queries, routing of information, security
• Relationship to architecture
• Combinations of data, metadata and technical
  standards
• Implementation guidance / specifications
• Transactions

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Dependencies - from Outcome to Initiation

• Testable interoperability
• Identified data and technical standards
• Detailed specifications
• Testing infrastructure
• Identified standards and specifications
• Valid process for identifying named standards
• Well maintained, implementation level guidance
• Accepted process for identifying standards
• Context for standards use
• Multi-stakeholder process
• Value and context for standards use
• Business value in information exchange
• Alignment with broader agenda

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Testing

• Challenges for testing
• Need to test
• Terminology value sets
• Messages / documents
• Web services
• Transport
• Security
• On-site implementation and testing
• Multiple, connected business processes
• Multiple participants and one to many
  interoperability
• Errors and error handling
• Technical tools to achieve

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A Nationwide Health Information Network
State and Local Gov
HealthBank
PCHR Support Organization
Community Health Centers
Common dial tone and chain of trust
Labs
Pharmacies
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Building Network Standards
Functional Needs
Transitions in Care
Quality Reporting
Results Delivery
Personal Health Records
ePrescribing
Lab Result Delivery
Biosurveillance
Other Priority Initiatives
Capabilities
Common Access to Health Organizations
Federated Information Management
Reusable infrastructure for health initiatives
Network Services
Information routing and delivery (including
summary patient records)
Patient lookup and Information retrieval
Provision of electronic data for reporting and
other uses
Exchange of Consumer Preferences
Distributed Query Support
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Solutions

• Ensure value in information exchange
• Have unambiguous and detailed specifications
• Have very specific technical testing to ensure
  implementation and ease development
• Have a reference implementation of the
  standards for use
• Develop a community of use