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”

Charles Jaffe, MD
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”

  1. 1. Enabling Interoperability Charles Jaffe, MD, PhD CEO, Health Level 7 Professor of Medicine, UCSD iHT2 HIT Summit Austin 11December 2013
  2. 2. CME Disclaimer: I don’t sell anything. Almost anything you may want from me is free.
  3. 3. Why would the conference producers place a presentation on standards right before lunch?
  4. 4. Best Guess: Because HL7 standards are the cornerstone of Meaningful Use 2 and will be even more critical in Meaningful Use 3.
  5. 5. Next Best Guess: Because HL7 standards are the only real hope of ever achieving Interoperability.
  6. 6. Why is Interoperability so hard?
  7. 7. I guess it depends upon what you mean by Interoperability.
  8. 8. Semantic Interoperability means the ability of two machines to exchange data, and to reuse the data that has been exchanged.
  9. 9. There are other kinds of Interoperability, but if you want to get to Plug-and-Play Interoperability then it’s even harder.
  10. 10. “All you need in this life is ignorance and confidence, and then success is sure.” Mark Twain
  11. 11. Reasons why Plug-and-Play Interoperability is so difficult: Too many standards.
  12. 12. 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.
  13. 13. Too many standards. The Australian rail system has 3 gauges of track.
  14. 14. “If you can't be a good example, then you'll just have to serve as a horrible warning.” Catherine Aird
  15. 15. Too many standards. Electric plugs. Is any further explanation needed?
  16. 16. Too many competing standards. Genomics The rule of Not Invented Here
  17. 17. Reasons why Plug-and-Play Interoperability is so difficult: Too few standards.
  18. 18. “Knowledge is knowing that a tomato is a fruit. Wisdom is not putting tomatoes in a fruit salad.” Peter Kay
  19. 19. Standards too difficult to understand, apply, manage, or implement
  20. 20. Healthcare is difficult. Data Elements needed for an ATM: 10
  21. 21. Healthcare is difficult. Unique English words: 450,000* * I would not like to debate the exact figure.
  22. 22. Healthcare is difficult. Unique terms in the National Library of Medicine Metathesaurus: 2.4 Million
  23. 23. (Sometimes) Government Regulatory Agencies make things more difficult than necessary.
  24. 24. What is this?
  25. 25. 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
  26. 26. “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
  27. 27. Some standards are too flexible.
  28. 28. Too flexible: HL7 Version 2 dreaded Z-segment.
  29. 29. One solution: Postel’s Principle Send conservatively. Receive liberally.
  30. 30. Some standards are not flexible enough.
  31. 31. Not flexible: The list is too long.
  32. 32. “How much easier it is to be critical than correct.” Benjamin Disraeli
  33. 33. Some standards are difficult (impossible) for humans to use.
  34. 34. Hard for humans to use: ICD-10 Impossible for humans to use: ICD-11
  35. 35. Some standards are interpreted differently by different folks.
  36. 36. HTML 4 How many web browsers do you need to use?
  37. 37. Some standards are implemented differently by different folks.
  38. 38. Same answer.* * Each web site has a different idea what HTML 4 requires.
  39. 39. “To be sure of hitting the target, shoot first, and call whatever you hit the target.” Ashleigh Brilliant
  40. 40. Well, what does HL7 actually do?
  41. 41. HL7 doesn't write software.
  42. 42. We make writing software more intuitive.
  43. 43. HL7 doesn't provide care for patients.
  44. 44. We make caring for patients safer.
  45. 45. HL7 doesn't do clinical research.
  46. 46. We make doing clinical research more effective.
  47. 47. HL7 doesn't pay for healthcare.
  48. 48. We make paying for healthcare less costly.
  49. 49. HL7 is developing standards that will change the way we exchange, analyze, and reuse healthcare data.
  50. 50. Here are 3 of them.
  51. 51. CDA: Clinical Document Architecture
  52. 52. 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.
  53. 53. 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
  54. 54. The very modular nature of CDA makes interoperability faster, easier, and cheaper.
  55. 55. Consolidated-CDA is the keystone to bridging from MU 2 to MU3
  56. 56. 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
  57. 57. New releases of CDA will fundamentally change how documents are exchanged
  58. 58. For terabyte instances of big data analytics, CDA has proven both scalable & reliable
  59. 59. Trifolia A portfolio of tools for storage, curation, retrieval, archiving and creation of templates for CDA, built with a unique template exchange language.
  60. 60. FHIR Fast Healthcare Interoperability Resources
  61. 61. FHIR A framework for the development of data exchange technology that offers the interoperability of the RIM, while hiding the complexity of V3
  62. 62. What makes FHIR fast? Faster to learn Faster to develop Faster to implement FHIR
  63. 63. A gentle word of caution about FHIR Current Status The Gartner Hype Cycle 2015-2016
  64. 64. FHIR Enables Mobile Health
  65. 65. CommonWell Embraces FHIR
  66. 66. BRIDG Model
  67. 67. 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
  68. 68. HL7 is more than standards
  69. 69. HL7 is about implementation
  70. 70. 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.
  71. 71. Help Desk
  72. 72. HL7 User Groups
  73. 73. International Healthcare IT Policy
  74. 74. Health Professionals Group
  75. 75. EMR Functional Model
  76. 76. Longitudinal PHR Functional Model
  77. 77. Blue Button Veterans Administration HL7 Blue Cross
  78. 78. Mobile Health
  79. 79. Privacy & Security
  80. 80. Claims & Claims Attachments
  81. 81. Genomics
  82. 82. Healthcare Quality Measures & Reporting
  83. 83. Conformance Testing & Certification
  84. 84. Conformance Testing & Certification • ISO 17025 Testing & Certification partners • Iterative, not once-and-done • Not a Connectathon model • Asynchronous – 7/24 • Process improvement focused
  85. 85. Education Services
  86. 86. HL7 Education Portal • • • • eLearning Program HL7 Competency Certification Webinar series Education Summits
  87. 87. Vocabulary Authority
  88. 88. If you haven’t had enough Interoperability for one morning, try…
  89. 89. Thanks