Hurdles and Solutions for the Interoperable EHR

1. Hurdles and Solutions for the Interoperable EHR John W, Loonsk, MD FACMI Chief Medical Officer CGI

2. Interoperability • Issues with the availability of definitive and detailed standards • Standards are necessary, but not sufficient for interoperability • Best way to advance standards is to have many people using them • Other challenges to interoperability: • Few incentives for exchanging information • When “value” of exchanging is high it costs to notbe interoperable • Many incentives for not exchanging information • Propriety business needs • Tacit “ownership” • Integration services profits • Existing non standards-based systems • Patient confidentiality issues • HIPAA and other legal angst • Subpoena concerns

3. Types of Standards • Data standards • Text and viewing • Terminologies and value sets • Metadata and XML “bins” • Technical standards • Queries, routing of information, security • Relationship to architecture • Combinations of data, metadata and technical standards • Implementation guidance / specifications • Transactions

4. Dependencies - from Outcome to Initiation • Testable interoperability • Identified data and technical standards • Detailed specifications • Testing infrastructure • Identified standards and specifications • Valid process for identifying “named” standards • Well maintained, implementation level guidance • Accepted process for identifying standards • Context for standards use • Multi-stakeholder process • Value and context for standards use • Business value in information exchange • Alignment with broader agenda

5. Testing Challenges for testing • Need to test • Terminology value sets • Messages / documents • Web services • Transport • Security • On-site implementation and testing • Multiple, connected business processes • Multiple participants and “one to many” interoperability • Errors and error handling • Technical tools to achieve

6. HIE SSA CDC CMS VA FDA DoD PHR HIE Fed HIE IDS HIE Geo HIE RHIO A Nationwide Health Information Network State and Local Gov HealthBank PCHR Support Organization Community Health Centers Common “dial tone” and “chain of trust” Labs Pharmacies

7. Building Network Standards Functional Needs Transitions in Care Quality Reporting Results Delivery ePrescribing Personal Health Records Biosurveillance Lab Result Delivery Other Priority Initiatives Capabilities Common Access to Health Organizations Federated Information Management Reusable infrastructure for health initiatives Network Services Information routing and delivery (including summary patient records) Patient lookup and Information retrieval Provision of electronic data for reporting and other uses Exchange of Consumer Preferences Distributed Query Support

8. Solutions • Ensure value in information exchange • Have unambiguous and detailed specifications • Have very specific technical testing to ensure implementation and ease development • Have a “reference implementation” of the standards for use • Develop a community of use