Interoperability. Doug Fridsma, MD PhD President & CEO, AMIA

Transcription

1 Interoperability Doug Fridsma, MD PhD President & CEO, AMIA

2 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

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4 It s not architecture, it s city planning Ultra-Large-Scale Systems The Software Challenge of the Future

5 It s not architecture. It s city planning

6 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

7 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 Transitions of Care Care summary Clinical Trial Eligibility Public Health Reporting Public Health Reporting

8 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

9 Think HORIZONTALLY rather than vertically Consumer empowerment Electronic Health Record and Quality Big Data and population health Clinical and Translational Research Patient Practice Population Public Informatics, standards, testing, business drivers, governance

10 Information Blocking and the Socio-Technical Stack Policy and Business drivers Implementation API Traditional technology stack Public Policy Intellectual Property Business Drivers Workflow (dynamic) Context (static) Services Semantic Syntactic Transport Security Legal Responsibilities (e.g. HIPAA, 42 CFR Part 2) Contractual Decisions (e.g. Epic App Orchard) Market-based Motivations (e.g. ACOs) When to apply the data (e.g. lab test results) How to apply the data (e.g. Admission v. Discharge Summary) Purpose-specific APIs and services that leverage the other four layers Terminologies, Structured data, coded (e.g. ICD-10, SNOMED) Message formatting (e.g. CCDA v2) How the message move from A to B How we ensure that messages are secure and private

11 Information Blocking and the Socio-Technical Stack Policy and Business drivers Implementation API Traditional technology stack Public Policy Intellectual Property Business Drivers Workflow (dynamic) Context (static) Services Semantic Syntactic Transport Security Legal Responsibilities (e.g. HIPAA, 42 CFR Part 2) Contractual Decisions (e.g. Epic App Orchard) Market-based Motivations (e.g. ACOs) When to apply the data (e.g. lab test results) How to apply the data (e.g. Admission v. Discharge Summary) Purpose-specific APIs and services that leverage the other four layers Terminologies, Structured data, coded (e.g. ICD-10, SNOMED) Message formatting (e.g. CCDA v2) How the message move from A to B How we ensure that messages are secure and private

12 Information Blocking and the Socio-Technical Stack Policy and Business drivers Implementation API Traditional technology stack Public Policy Intellectual Property Business Drivers Workflow (dynamic) Context (static) Services Semantic Syntactic Transport Security Legal Responsibilities (e.g. HIPAA, 42 CFR Part 2) Contractual Decisions (e.g. Epic App Orchard) Market-based Motivations (e.g. ACOs) When to apply the data (e.g. lab test results) How to apply the data (e.g. Admission v. Discharge Summary) Purpose-specific APIs and services that leverage the other four layers Terminologies, Structured data, coded (e.g. ICD-10, SNOMED) Message formatting (e.g. CCDA v2) How the message move from A to B How we ensure that messages are secure and private

13 Information Blocking and the Socio-Technical Stack Policy and Business drivers Implementation API Traditional technology stack Public Policy Intellectual Property Business Drivers Workflow (dynamic) Context (static) Services Semantic Syntactic Transport Security Legal Responsibilities (e.g. HIPAA, 42 CFR Part 2) Contractual Decisions (e.g. Epic App Orchard) Market-based Motivations (e.g. ACOs) When to apply the data (e.g. lab test results) How to apply the data (e.g. Admission v. Discharge Summary) Purpose-specific APIs and services that leverage the other four layers Terminologies, Structured data, coded (e.g. ICD-10, SNOMED) Message formatting (e.g. CCDA v2) How the message move from A to B How we ensure that messages are secure and private

14 Information Blocking and the Socio- Technical Stack Policy and Business drivers Implementation API Traditional technology stack Public Policy Intellectual Property Business Drivers Workflow (dynamic) Context (static) Services Semantic Syntactic Transport Security Care summary Transitions of Care Clinical Trial Eligibility Legal Responsibilities (e.g. HIPAA, 42 CFR Part 2) Contractual Decisions (e.g. Epic App Orchard) Market-based Motivations (e.g. ACOs) When to apply the data (e.g. lab test results) How to apply the data (e.g. Admission v. Discharge Summary) Purpose-specific APIs and services that leverage the other four layers Terminologies, Structured data, coded (e.g. ICD-10, SNOMED) Message formatting (e.g. CCDA v2) How the message move from A to B How we ensure that messages are secure and private Public Health Reporting Public Health Reporting

15 SO HOW DO WE GET THERE? AMIA PowerPoint Template 15

16 THE PATH OF LEAST REGRET: THREE THINGS WE NEED

17 BUILD DOCUMENTS FROM DATA, NOT THE OTHER WAY AROUND

18 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

19 FULL EXPORT OF THE PATIENT RECORD (AND NARRATIVE)

20 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

21 TEST BOTH SIDES OF EXCHANGE

22 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

23 Doug Fridsma MD PhD THANK YOU! Official Group of AMIA AMIA informatics #WhyInformatics 23

24 AMIA is the professional home for more than 5,400 informatics professionals, representing frontline clinicians, researchers, public health experts and educators who bring meaning to data, manage information and generate new knowledge across the research and healthcare enterprise. AMIA 2017 amia.org Official Group of AMIA AMIA informatics #WhyInformatics 24