Enabling Interoperability

Charles Jaffe, MD, PhD CEO, Health Level 7

Professor of Medicine, UCSD

iHT2 HIT Summit

Austin

11December 2013

CME Disclaimer:

I don’t sell anything. Almost anything

you may want from me

is free.

Why would the conference producers

place a presentation

on standards

right before lunch?

Best Guess:

Because HL7 standards are the

cornerstone of

Meaningful Use 2

and will be even more critical in

Meaningful Use 3.

Next Best Guess:

Because HL7 standards are the

only real hope of ever

achieving Interoperability.

Why is Interoperability so hard?

I guess it depends upon what

you mean by

Interoperability.

Semantic Interoperability means

the ability of two machines to

exchange data,

and

to reuse the data that has

been exchanged.

There are other kinds of

Interoperability,

but if you want to get to

Plug-and-Play Interoperability

then it’s even harder.

“All you need in this life is

ignorance and confidence,

and then success is sure.”

Mark Twain

Reasons why Plug-and-Play

Interoperability is so difficult:

Too many standards.

Too many standards.

The last time I’m certain that

the US got it right was 1861.

The government mandated

one gauge of track for the

Continental Railroad.

Too many standards.

The Australian rail system

has 3 gauges of track.

Catherine Aird

“If you can't be a good

example, then you'll just have

to serve as a

horrible warning.”

Too many standards.

Electric plugs.

Is any further explanation needed?

Too many competing standards.

Genomics

The rule of Not Invented Here

Reasons why Plug-and-Play

Interoperability is so difficult:

Too few standards.

“Knowledge is knowing that a

tomato is a fruit.

Wisdom is not putting

tomatoes in a fruit salad.”

Peter Kay

Standards too difficult to

understand,

apply,

manage, or

implement

Healthcare is difficult.

Data Elements needed for an

ATM: 10

Healthcare is difficult.

Unique English words:

450,000*

* I would not like to debate the exact figure.

Healthcare is difficult.

Unique terms in the

National Library of Medicine

Metathesaurus:

2.4 Million

(Sometimes) Government

Regulatory Agencies

make things more difficult

than necessary.

What is this?

European Commission Regulation No. 1677/88:

bananas are allowed a bend of 10mm per 10cm of length

European Commission Regulation No. 2257/94:

bananas must be "free from malformation or abnormal

curvature“

Sorry, EC Regulation says this is

not a banana.

“If the Federal Government

were put in charge of the

Sahara Desert,

in five years we would

run out of sand.”

Milton Friedman

American Economist

Some standards are

too flexible.

Too flexible:

HL7 Version 2

dreaded Z-segment.

One solution: Postel’s Principle

Send conservatively.

Receive liberally.

Some standards are

not flexible enough.

Not flexible:

The list is too long.

Benjamin Disraeli

“How much easier it is to be

critical than correct.”

Some standards are

difficult (impossible)

for humans to use.

Hard for humans to use:

ICD-10

Impossible for humans to use:

ICD-11

Some standards are

interpreted

differently by different folks.

HTML 4

How many web browsers do you

need to use?

Some standards are

implemented

differently by different folks.

Same answer.*

* Each web site has a different idea what

HTML 4 requires.

Ashleigh Brilliant

“To be sure of hitting the target,

shoot first, and call whatever

you hit the target.”

Well, what does HL7

actually do?

HL7 doesn't

write software.

We make

writing software

more intuitive.

HL7 doesn't provide

care for patients.

We make caring

for patients

safer.

HL7 doesn't

do clinical research.

We make

doing clinical research

more effective.

HL7 doesn't

pay for healthcare.

We make

paying for healthcare

less costly.

HL7

is developing standards that

will change the way we

exchange,

analyze,

and reuse

healthcare data.

Here are

3

of them.

CDA: Clinical

Document Architecture

Think of CDA as an envelope

in which you can put any document,

like a report or EKG or image.

Mayo Clinic

Department of Immunology

200 1st St SW

Rochester, MN 55905

Charles Jaffe, MD

Department of Medicine

University of California

La Jolla, CA 92037

• Securely identified

• Unaltered document formatting

• Machine processable

• Human readable

• Combined structured data & free text

• Easily mined for complex data signals

• Scalable for both text & large image files

Characteristics of CDA Documents

The very modular nature

of CDA makes interoperability

faster,

easier,

and cheaper.

Consolidated-CDA

is the keystone to bridging

from MU 2 to MU3

• Public Health reporting

• Clinical Decision Support

• Regulatory submissions for Clinical Trials

• Quality Measures

• ePrescribing

• Personal Health Records

• Procedure reports & Operative notes

Some Current Applications of CDA

New releases of

CDA

will fundamentally

change

how documents

are exchanged

For terabyte instances of

big data analytics,

CDA has proven both scalable & reliable

A portfolio of tools

for storage, curation, retrieval, archiving

and creation of templates for CDA,

built with a unique

template exchange language.

Trifolia

FHIR

Fast Healthcare Interoperability

Resources

FHIR

A framework for the development of

data exchange technology that offers

the interoperability of the RIM, while

hiding the complexity of V3

FHIR

What makes FHIR fast?

Faster to learn

Faster to develop

Faster to implement

A gentle word of caution about FHIR

Current Status

2015-2016

The

Gartner

Hype

Cycle

FHIR Enables

Mobile Health

CommonWell

Embraces

FHIR

BRIDG

Model

BRIDG Model

• Biomedical Research Integrated

Domain Group

• A domain analysis model of the

HL7 RIM

• Seamlessly integrates patient care

and clinical research data

• Integrates with regulatory submission

processes

• Supports the Learning Health System

HL7

is more than

standards

HL7

is about

implementation

If it couldn’t get any more

overwhelming,

I’ll try to describe

15 new Implementation Programs

in the next 5 minutes.*

* No, you don’t have to take notes.

I’ll give you these slides.

Help Desk

HL7 User

Groups

International Healthcare IT Policy

Health

Professionals

Group

EMR

Functional

Model

Longitudinal

PHR

Functional

Model

Blue Button

Veterans Administration

HL7

Blue Cross

Mobile Health

Privacy

& Security

Claims &

Claims Attachments

Genomics

Healthcare Quality

Measures

& Reporting

Conformance Testing

& Certification

• ISO 17025 Testing & Certification partners

• Iterative, not once-and-done

• Not a Connectathon model

• Asynchronous – 7/24

• Process improvement focused

Conformance Testing

& Certification

Education Services

HL7 Education Portal

• eLearning Program

• HL7 Competency Certification

• Webinar series

• Education Summits

Vocabulary

Authority

If you haven’t had enough

Interoperability

for one morning, try…

www.HL7.org

Thanks

cjaffe@hl7.org