Becker's Hospital Review

70 THOUGHT LEADERSHIP Why Interoperability Still Eludes Healthcare: Q&A With Dr. Charles Jaffe CEO of HL7 By Max Green H ealth Lev- el Seven International has been fighting the good fight for interoperability since it was founded in 1987. The group has created, defined and spearheaded initia- tives to enable the widespread adop- tion of interoperable standards. HL7's latest standard, Fast Healthcare Interoper- ability Resources, or FHIR, is being tested and implemented in healthcare settings worldwide for facilitating electronic infor- mation exchange. But HL7's focus on in- teroperability goes beyond healthcare, and the standards the group works to develop are applicable to federal agencies such as the Food and Drug Administration and the Department of Veterans Affairs, among others around the world. Charles Jaffe, MD, PhD, CEO of HL7, took time to speak with Becker's Hospital Review about HL7's stan- dards, how vendors fit into the picture and why we still don't have seamless interoperability. Q: How do you explain HL7 and its goals when you're doing outreach for the organization? Dr. Charles Jaffe: HL7 is thousands of volunteers all over the world — we're in more than 40 countries whereby stat- ute or de facto. We are the standards by which healthcare information is ex- changed on a multitude of platforms for different reasons. That includes pa- tient care — in the United States for glucose readings, you could review the information quickly. at would give you the chance to adjust her medica- tions, if need be, and coach her on ways to keep her glucose in tighter control. Or perhaps you'd have the chance to confirm that the diabetes was actually under good control, and do a proac- tive review to address other issues that may put her at risk for a major medical event. If your digital assistant routinely pulled in pharmacy information, you could see if Mrs. Johnson was filling her prescriptions on schedule. If she isn't, you could find out why and help her solve the problem. A study pub- lished in 2014 in the Annals of Inter- nal Medicine found that nearly a third of all new prescriptions weren't filled within nine months; a survey by the group Prescriptions for a Health Amer- ica (a coalition of physicians, patients and pharmacy and healthcare industry groups) found that approximately 60 percent of patients don't take medica- tions as they are prescribed. e group also found that better medication ad- herence resulted in significant reduc- tions to other medical costs. And how about co-morbidities that result in visits to specialists? You could be alerted if Mrs. Johnson fills a prescription from a cardiologist or rheumatologist or an orthopedist or any other physician. at's important information, because you want to be sure that any new medications won't in- teract negatively with the medications she is already taking. And you want to know if she has other health problems that she might not have mentioned to you. If those other physicians also had a digital assistant that mined the phar- macy system, they'd be alerted to what medications you are prescribing. at would help all of Mrs. Johnson's care- givers provide higher quality medical services, and possibly provide Mrs. Johnson with a better quality of life at a lower cost overall. It would also offer her an opportunity to see, use and share her own medical record and informa- tion with her care team and family. A new standard for data will help To make all this rummaging in the data easier and more accurate, HL7, the international group working on in- teroperability issues, has a new standard and application programming interface called Fast Healthcare Interoperability Resources, also known as FHIR (pro- nounced like fire). is new standard is just beginning to be used, and one of its goals is "to facilitate interoperation between legacy healthcare systems, to make it easy to provide healthcare in- formation to healthcare providers and individuals on a wide variety of de- vices from computers to tablets to cell phones, and to allow third-party appli- cation developers to provide medical applications which can be easily inte- grated into existing systems." FHIR should greatly advance devel- opment of the kind of interfaces we need to make EHRs easier to use and more clinically useful. Physicians can aid that advancement by insisting that any new applications or tools adopted are based on these standards. If vendors get on board and use these standards, we'll see a revolution in how physicians, nurses and oth- er caregivers interact with EHRs. e good news: Vendors seem to like the new standards, and they are quickly moving to use them. Nick van Terheyden, MD, is CMO of Dell Healthcare & Life Sciences. He previously served as CMIO of Nuance Communications. Dr. van Terheyden is a 25-year veteran of healthcare tech- nology. He aided in the development of one of the first EMRs and served as a business leader in one of the first speech recognition Internet companies. He is a graduate of the Royal Free Hospital School of Medicine, Univer- sity of London and has several profes- sional memberships including HIMSS, mHealth Executive Committee, AMIA and AMDIS. n

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