As National Coordinator for Healthcare Information Technology, DeSalvo put interoperability center stage when she released on Jan. 30, an interoperability roadmap along with rules of engagement. "Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0" outlines steps "that will enable a majority of individuals and providers across the care continuum to send, receive, find and use a common set of electronic clinical information at the nationwide level by the end of 2017."
In September 2014, when she spoke at the AHIMA annual convention, she promised an audience of AHIMA members the government would act "fast into interoperability." She drew applause when she added, "We cannot wait for 10 years to get this done."
Fridsma joined the American Medical Informatics Association as president and CEO last November. Prior to AMIA, he served in the position of Chief Science Officer at the Office of the National Coordinator for Health Information Technology. creating the Standards and Implementation Framework, a community-driven platform to accelerate the development of national, consensus-based standards. Through the SI Framework, he led development of national standards for electronic patient care summary reports, laboratory reporting, and secure email information exchange.
Galvez has become the point woman for interoperability and data exchange.
In addition to the "tremendous uptake in EHRs," Galvez noted at a recent joint meeting ot the Health IT Policy and Health IT Standards meeting, "one-third of doctors are exchanging different pieces of information such as allergies, lab results and medications, and that half of physicians receive discharge summaries. Among hospitals, 51 percent are able to query patient records electronically, and 41 percent can exchange secure messages containing patient data with external sources."
"Exchange is happening now," Galvez said, acknowledging that "it doesn't necessarily meet our definition of interoperability."
Grieve is principal at Health Intersections Pty Ltd, in Melbourne, Australia, an active participant in HL7 International and credited as the original developer of FHIR.
"FHIR was born out of frustration with the overall direction of HL7 (i.e. v2, v3, and CDA). V2 has been great, but has come to the end of the road. V3 has tremendous strengths but in the end it failed – too much too soon, I think," he told HL7 blogger Chad Johnson back in 2013.
"FHIR was kind of an accident," he said. "HL7 created a fresh look task force and I wondered what it would look like if I took a modern internet approach and rewrote it for health (I actually picked the Highrise API). I drafted something, and it took off like, well, wildfire. And here we are."
Halamka, vice chair of the federal Health IT Standards Committee, has been leading standards efforts for at least a dozen years, but the enthusiasm for the work has not waned.
Note his comment in a March 2015 blog: "The March 2015 HIT Standards Committee was one of the most impactful meetings we have ever had. No, it was not the release of Meaningful Use Stage 3 or the certification rule. It was the creation of a framework that will guide all of our work for the next several years - everything we need for a re-charted standards harmonization convening body as well as a detailed interoperability roadmap, complementing the 10 year general plan developed by ONC. Thanks to Arien Malec for yeoman’s work in both areas."
In his role as CTO of Healtheway, Heflin promotes interoperability every chance he gets. Part of his work is to support Healtheway's mission to:
• Provide a neutral forum for public-private collaboration
• Foster development and ongoing support for governance frameworks
• Facilitate consensus agreement on the policies and standards to minimize barriers to interoperability
• Provide services that enable health information exchange networks to interoperate
As CEO of standards organization HL7, Jaffe has seen many efforts toward an interoperable health system come and go. Today, he's excited about the promise of FHIR. The acronym stands for Fast Healthcare Interoperability Resources. It's pronounced "fire." He describes FHIR as a platform and a set of rules.
"If you want to use it for consumer or patient-centric information delivery, or you want to use it for a novel idea about wellness, you can. It doesn't limit you the way messaging does. Moreover when you want to query a system, you don't have to have a registry. FHIR allows you to query systems that have FHIR capability independent of registries. Not only is it easy to use and is fast to develop and implement, but it's also inordinately flexible."
FHIR is offered free by HL7. There is no charge for the license and users are not required to be HL7 members. FHIR is a draft standard today, with plans for HL7 to make it a normative standard in 2016.
As director for interoperability informatics at New York-Presbyterian Hospital, Kuperman helps the hospital advance its health information exchange and care coordination strategies. From 1992-2003, he worked in the Information Systems Department at Partners HealthCare in Boston, where he focused on the design, development, implementation and evaluation of clinical decision support systems.
"Technology is only one obstacle to interoperability," Kuperman said at an AMIA panel discussion back in 2012. Among the other obstacles mentioned during that discussion: Hospitals can have hundreds of IT systems, vendors have built proprietary databases, not everyone follows the same standards, health systems fear sharing data with competitors and policymakers have not focused on health information exchange or EHR usability.
Interoperability has been top of mind for Loonsk over many years. He worked in the Office of the National Coordinator for Health Information Technology from 2005 to 2009, where he served as director of interoperability and standards.
"Part of the interoperability problem is that only a limited amount of the HITECH meaningful use leverage has been used to encourage data exchange. Interoperability took a back seat to adoption of EHRs and other things in meaningful use plans," he wrote in an analysis piece published on the Healthcare IT News website, Sept. 22, 2014. "But another part of the problem is that there is no real technical plan. From a health IT perspective, the kind of 'plan' that is needed would describe high-level functional needs, identify important technical elements, and show how they all fit together."
As vice president for the data platform solution line at RelayHealth, Malec addresses improved care, improved health, and cost containment through the use of clinical data. Before taking on that role, he had an 18 month stint at the Office of the National Coordinator, as coordinator for the Direct Project and the Standards and Interoperability Framework. Malec is a member of the federal Health IT Standards Committee. Committee vice chair, John Halamka, MD, praised Malec's diligence in his March 18 blog: "The March meeting of the panel was one of the most impactful ever," Halamka said, because of the "creation of a framework that will guide all of our work for the next several years – everything we need for a re-charted standards harmonization convening body as well as a detailed interoperability roadmap, complementing the 10 year general plan developed by ONC. Thanks to Arien Malec for yeoman's work in both areas."
As Posnack sees it, interoperability requires work from both the private and the public sector. There are a number of standards today that need work to help refine the detail and the variability. "In some cases, it's constraining, he said at the American Journal of Managed Care discussion last November.
At HIMSS15, Posnack will be presenting at two sessions: "Advancing Interoperability and Standards" (with Erica Galvez) and "Interoperability & Standards Networking Breakfast and Panel Presentation: Accelerating Interoperability through Collaboration: A Fireside Chat".
Rishel recently retired as vice president and distinguished analyst in Gartner's healthcare provider research practice. He covered electronic medical records, interoperability, health information exchanges and the underlying technologies of healthcare IT, including application integration and standards.
He continues to work on the interoperability front as a member of Interoperability and Health Information Exchange, Jason Task Force and Health IT Standards Committee.
In her role as director of professional services for HIMSS, Sensmeier oversees clinical informatics, standards and interoperability. She led the advancement of Integrating the Healthcare Enterprise, an international standards profiling organization which, over the past decade, has achieved both regional and international adoption of its public domain technical framework. She is president of IHE USA, and previously served as the Standards Implementation Technical Manager for the Healthcare Information Technology Standards Panel.
Sensmeier is also credited for launching the popular Interoperability Showcase at the annual HIMSS Conference and Exhibition.
"As a clinician, you maybe touch one patient at a time," Shrestha says, "but when you're doing the things that I'm fortunate enough to be part of the team that's doing, you have the potential to touch hundreds if not thousands and more patients at a time."
As Shrestha sees it, the fundamental challenge with interoperability remains that in the last decade or more, the industry – even UPMC – has been proliferating silos.
On April 16 at HIMSS15, Shrestha and Ranga Chandra Gudivada, manager for Enterprise Vocabulary Services at UPMC, will present "Beyond the Hype: Achieving True Semantic Interoperability".
Trivedi's focus is on improving healthcare delivery through secure, interoperable health information technology systems. He manages the healthcare vertical at ICSA Labs, an independent division of Verizon. Trivedi developed and launched testing and certification programs that support the nation's healthcare providers, hospitals, health IT vendors and system developers in meeting regulatory requirements, while continuing to drive innovation.
ICSA Labs is an Office of the National Coordinator Authorized Certification Body that tests and certifies EHR technology that meets federal requirements to support meaningful use of health IT.
