NAM presentation v3 · Restore the importance of the narrative and unstructured text Patients are more than a collection of discrete data • Disease vs. illness • The importance

Doug Fridsma, MD PhDPresident & CEO, AMIA

Interoperability

Getting to Interoperability

2AMIA PowerPoint Template

• To get to interoperability (or to avoid information blocking) we need a common understanding of the problem

• Can’t solve the problem all at once• Need to break it into pieces that allow different groups to work on different parts of the

problem

• How we frame the problem will affect the solution(s) we get• Ultra-large scale system• Definition of Interoperability

It’s not architecture, it’s city planning

Software Engineering Institute Carnegie Mellon University 4500 Fifth Avenue Pittsburgh, PA 15213-3890

Phone: 412-268-5800 Fax: 412-268-5758 www.sei.cmu.edu [email protected]

© Copyright 2006 Carnegie Mellon University.

Ultra-Large-Scale SystemsThe Software Challenge of the Future

Ultra-Large-S

cale System

s: The Softw

are Challenge of the Future

It’s not architecture. It’s city planning

Interoperability (IEEE)• Ability of two or more systems to exchange information• Ability of those systems to use the information that has been exchanged

Interoperability only makes sense in the context of what you want to DO

Transitions of Care

Care sum

mary

Clinical Trial Eligibility

Public Health R

eporting

Public Health R

eporting

“Silos of Interoperability”• Define Interoperability in terms of

the ”thing you want to do”• Without coordination across

there is no shared “building blocks”

• This creates confusion• Quality measures• Data Registries• Clinical Decision Support• EHRs• Non-health data• etc

You need a framework to pull together the different use cases

8

“You can’t build a skyscraper by nailing 10,000 dog houses together”

Patient Practice Population Public

Think HORIZONTALLY rather than vertically

Informatics, standards, testing, business drivers, governance

Big Data and population health

Electronic Health Record and

Quality

Consumer empowerment

Clinical and Translational

Research

Information Blocking and the Socio-Technical Stack

Legal Responsibilities (e.g. HIPAA, 42 CFR Part 2)Public PolicyContractual Decisions (e.g. Epic App Orchard)Intellectual PropertyMarket-based Motivations (e.g. ACOs) Business DriversWhen to apply the data (e.g. lab test results)Workflow (dynamic)How to apply the data (e.g. Admission v. Discharge Summary)Context (static)Purpose-specific APIs and services that leverage the other four layersServicesTerminologies, Structured data, coded (e.g. ICD-10, SNOMED)SemanticMessage formatting (e.g. CCDA v2)SyntacticHow the message move from A to BTransportHow we ensure that messages are secure and privateSecurity

Traditional technology stack

Implementation

Policy and Business drivers

API




Implementation


API




Implementation


API




Implementation


API




Implementation


APITransitions of C

are

Care sum

mary

Clinical Trial Eligibility

Public Health R

eporting

Public Health R

eporting

SO HOW DO WE GET THERE?

AMIA PowerPoint Template 15

THE PATH OF LEAST REGRET: THREE THINGS WE NEED

BUILD DOCUMENTS FROM DATA, NOT THE OTHER WAY AROUND

What is needed: A common format for granular data• Common data formats for

• Text data• Categorical data• Numerical data• More…

• This is the beginning of the “horizontal coordination” across different use cases

• Quality Measures• Clinical Decision Support• Registries

FULL EXPORT OF THE PATIENT RECORD (AND NARRATIVE)

Restore the importance of the narrative and unstructured textPatients are more than a collection of discrete data

• Disease vs. illness• The importance of the narrative to understanding patients

The unstructured data is where discoveries are made• Precision medicine

Restore the balance of power for access to data• Empower patients, researchers, public health officers

TEST BOTH SIDES OF EXCHANGE

Postel’s principleWhen you send, conform to the standard

• Pick a set of options and make sure it conforms to a valid instance of the standard

When you receive, accept ANY version that conforms to the standard• Any variation that is valid

Create the conditions of interoperability when you create the standard, rather than when you implement it

AMIA

@AMIAinformatics

Official Group of AMIA

AMIA informatics

www.amia.org

#WhyInformatics

Doug Fridsma MD PhD

23

THANK [email protected]

AMIA

@AMIAinformatics

Official Group of AMIA

AMIA informatics

www.amia.org

#WhyInformatics

AMIA is the professional home for more than 5,400 informatics professionals, representing frontline clinicians, researchers, public health experts and educators who bring meaning to data, manage information and generate new knowledge across the research and healthcare enterprise.

24AMIA 2017 | amia.org

Documents

NAM presentation v3 · Restore the importance of the narrative and unstructured text Patients are more than a collection of discrete data • Disease vs. illness • The importance