Issue link: https://beckershealthcare.uberflip.com/i/633033
71 PRACTICE MANAGEMENT THOUGHT LEADERSHIP example, our work with CMS helps provide data on billing and quality measures. In most countries there are enormous initiatives around public health where we provide the standards for a host of public health problems, from consolidating quality data to im- munization records and other registries. We also support national require- ments in different countries that are unique to those countries. In the Unit- ed States, that refers to meaningful use, and other countries have tak- en some of the meaningful use re- quirements from the United States and leveraged the exact same stan- dards we've developed here to not only simplify their national agenda, but ensure interoperability of health- care providers across national borders. Q: HL7 is often associated with increasing interoperability but is a very multi-faceted organization. How important is interoperability in the big picture? CJ: I think interoperability is the key. There are many different definitions of interoperability, though — semantic in- teroperability, which the technophiles like to throw around, or business in- teroperability, workflow, utilization and so forth. The fact is we need to have data exchange among entities, so we're not limiting the kinds of data that simply support one patient being cared for by one clinician. In today's world we have a multitude of stakeholders in the continu- um of healthcare delivery and wellness. In the inpatient paradigm it's fairly simple, but the continuity of care and the types of individuals who interact with patients, loved ones and con- sumers to support people is growing, and they need that data to make de- cisions. Even more importantly, as we move toward a new vision of patient care and wellness, the data needs to be in a form that validates the effica- cy and cost of intervention, whether it's medications or procedures or studies. Q: Does the technology exist today to make healthcare completely in- teroperable? CJ: No, it doesn't exist now. And some of the obstacles relate to the way a multitude of standards evolve, the re- quirements for customization or local- ization and the technical barriers associ- ated with it. I believe policy supervenes technology. We've heard a lot in the last year about interoperability block- ing. That's a serious misconception. There's often very little business case to develop solutions for interop- erability or even health information ex- change — end users, such as health sys- tems, aren't keen on sharing data and clinicians and providers misinterpret HIPAA requirements. The benefactor is often the patient and there's no way to sustain a business model with the pa- tient at the center of the system. There are a number of competing platforms and philosophies that aim to achieve this, but to date none of them have become as important as the payment system needs. Until the policy changes, that's not going to happen very quickly. Q: One of the challenges sur- rounding interoperability is figuring out how to incentivize stakeholders to participate, how do you view this issue? CJ: The ultimate question is interoper- able for whom? If you have a business case to share data between the lab, the electronic order entry, the billing entity, patient care providers and tax systems, it is one level of requirement. But to share it outside of your entity re- quires either a unified system or one- off mapping of resource to resource. For example, simply designating gen- der, male-female, mf, 0-1, can be a hur- dle if two systems can't agree. Then you need an interface to map the two. Then it gets far more complex when you have patient identification at the heart of this. For example, in South- ern California there are 10,000 people named Maria Gonzalez. Kaiser Perma- nente does its very best to issue them unique patient identifiers, but it's still a challenge. I've been told by the folks in Utah they have very similar naming problems. Until we embrace the notion of a unique patient identifier, we're go- ing to have interoperability problems sharing patient data between systems. Our matching algorithm, while very good, doesn't achieve 100 percent ac- curacy. All you have to do is look at your own credit report. There are likely at least dozens of people with your name. Not only does their information make it into your credit report, but matching algorithms pull in data from people you might share just a first name or last name with. How did the matching algorithms based on Social Security number get so inaccurate? I don't know the answer to that, but until we have a unified sys- tem for the United States population, we'll still have interoperability problems. Q: What is HL7's relationship like with the larger EHR vendors in the United States? CJ: We've always had excellent rela- tions with the EHR vendors, but FHIR has driven a level of cooperation and collaboration that frankly we've never seen. When I announced The Argno- aut Project in December 2014, most of the press was focused on the fact Epic and Cerner were at the table to- gether, not that there was this unique project about accelerating interopera- bility. Today we have ongoing Argo- naut projects around fast development and fast identification of problems. All of these require weekly confer- ence calls among the big vendors in the United States, and they collaborate at a level not before seen in terms of devel- oping FHIR-based solutions in terms of security, authentication and data iden- tification. These partnerships are re- markably open and collaborative; I can't speak more highly about the new level of cooperation that The Argonaut Project has fostered. n 71 THOUGHT LEADERSHIP