Health IT Summit Austin 2013 - Case Study "Enabling Data Interoperability through the Healthcare Continuum”
 

Health IT Summit Austin 2013 - Case Study "Enabling Data Interoperability through the Healthcare Continuum”

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Case Study "Enabling Data Interoperability through the Healthcare Continuum” ...

Case Study "Enabling Data Interoperability through the Healthcare Continuum”

Charles Jaffe, MD
CEO
Health Level 7 (HL7)

iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.

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    Health IT Summit Austin 2013 - Case Study "Enabling Data Interoperability through the Healthcare Continuum” Health IT Summit Austin 2013 - Case Study "Enabling Data Interoperability through the Healthcare Continuum” Presentation Transcript

    • 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.
    • “If you can't be a good example, then you'll just have to serve as a horrible warning.” Catherine Aird
    • 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?
    • Sorry, EC Regulation says this is not a banana. European Commission Regulation No. 2257/94: bananas must be "free from malformation or abnormal curvature“ European Commission Regulation No. 1677/88: bananas are allowed a bend of 10mm per 10cm of length
    • “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.
    • “How much easier it is to be critical than correct.” Benjamin Disraeli
    • 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.
    • “To be sure of hitting the target, shoot first, and call whatever you hit the target.” Ashleigh Brilliant
    • 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 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 in which you can put any document, like a report or EKG or image.
    • Characteristics of CDA Documents • 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
    • The very modular nature of CDA makes interoperability faster, easier, and cheaper.
    • Consolidated-CDA is the keystone to bridging from MU 2 to MU3
    • Some Current Applications of CDA • Public Health reporting • Clinical Decision Support • Regulatory submissions for Clinical Trials • Quality Measures • ePrescribing • Personal Health Records • Procedure reports & Operative notes
    • New releases of CDA will fundamentally change how documents are exchanged
    • For terabyte instances of big data analytics, CDA has proven both scalable & reliable
    • Trifolia A portfolio of tools for storage, curation, retrieval, archiving and creation of templates for CDA, built with a unique template exchange language.
    • 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
    • What makes FHIR fast? Faster to learn Faster to develop Faster to implement FHIR
    • A gentle word of caution about FHIR Current Status The Gartner Hype Cycle 2015-2016
    • 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
    • Conformance Testing & Certification • ISO 17025 Testing & Certification partners • Iterative, not once-and-done • Not a Connectathon model • Asynchronous – 7/24 • Process improvement focused
    • 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