At HIMSS15, I had to the pleasure of teaming with Mandi Bishop and four health IT leaders to organize our annual #HITsm live event. The previous three events mostly consisted of a meet and greet and passing the microphone around for introductions and discussions. This year’s event was the best HIMSS event yet, in my opinion, with approximately 150 in attendance, which was due in large part to our expert panel who graciously agreed to attend our unique session — with no assurance of it being a success — to answer questions from our passionate #HITsm community.

After I had the pleasure of briefly welcoming everyone in attendance and describing what we had planned for the session, Mandi then led the panelists through a set of four questions we solicited from an #HITsm tweetchat.

After introductions I realized it would be a good idea to record the session and share the transcript with those unable to attend in person. It appears that I didn’t start my recording until halfway through question one, but I did capture a majority of the discussion. Since the transcript is so long, I’m breaking this up into two parts. This post will cover the first two topics presented to the panel:

1. Let’s say in 5-7 years FHIR has eliminated a lot of the complaining about health data interoperability, what will become the new “top problem” for health IT?
2.  Should interoperability compliance be regulated by the government, or will market drivers force change? And, is interoperability – syntactic and semantic – truly a realistic goal?

First, a special thanks to our four panelists:

• Keith Boone, Standards Geek for GE Healthcare
• Dr. Doug Fridsma, President and CEO of AMIA
• David Muntz, Senior VP and Chief Information Officer at GetWellNetwork
• Dr. Rasu Shrestha, Chief Innovation Officer at University of Pittsburgh Medical Center and Executive Vice President of UPMC Enterprises

Part 1 of the transcript:

Question 1: Let’s say in 5-7 years FHIR has eliminated a lot of the complaining about health data interoperability, what will become the new “top problem” for health IT?

Rasu Shrestha: Hopefully we won’t be blinded by buzz words when it comes to FHIR. Hopefully, we will have something that will be of substance.

Let’s assume that FHIR actually does solve for the data, health data, and interoperability challenges that we’ve had in the last decade in the industry. I think we’ll still have issues that we’ll have to contemplate to go on the theme of the patient.

We’ve talked a lot about patient engagement, but what does that really mean? How do you create the right business models to sustain, not just patient engagement, but engagement to empower and to enable it? I think that’s going to be huge from a payer perspective because I think the reality, in the last five to seven years, the reality of health care in the United States is that this is not just a provider-driven world.

We’re seeing already the shift of risk moving from the payer to the provider and soon to the consumer. In that dynamic, the conversation really has to shift from intelligent management of disease, which is what we’ve been doing for decades now, of management may be more intelligent than others, to better management of wellness. Disease management is cost-acceleration and wellness, conversations around wellness, really pushing for wellness, that’s cost-deceleration. So, I think that’s going to be pretty interesting.

Mandi Bishop: So, what we’re talking about here is addressing the other 90 percent of health care that takes place outside the clinical setting. Is that, going to be the next thing?

Doug Fridsma: Would that FHIR could solve all of those problems. I do think that there is going to be a shift from an emphasis on the EHR and the practice and I think it’s going to be a shift to focusing on the individual, the person, in terms of all of the different devices that are going to be coming and then population health as well. I think that’s going to be another aspect that’s going to be important with all of this.

I think FHIR will solve some of the technical issues that we have. We still have a long ways to go. We’re right on the very top of the Gartner Hype Curve. I think, actually… it’s going to solve the Iraqi problem. There’s an obsession about that.

But I do think that we’re going to have some struggles over the course of next couple of days, couple of years as we have to start developing profiles and figuring out and agreeing on a way in which we’re going to exchange the information.

I actually think that, even if we have the technical problem solved, there are three other things you need to get to interoperability that we don’t often talk about it because we tend to be pretty technical.

The first is context, you have to know where the data came from so that you know how to use it if you’re going to be able to use it effectively. The second thing is workflow, you need to know where you are in the process and where you’re going to go next. And then the third of the things that you really need is policy and business practice. It has to make sense and there have to be rules that say that you can do it.

So, even if you have all the technical, semantic and syntactic interoperability worked out, you have to have context, workflow and policy business drivers to really get to true interoperability.

Question 2: Should interoperability compliance be regulated by the government? Should that contact, should that be supplied by the government or will market drivers force change? And is interoperability, syntactic and semantic, truly a realistic goal?

Doug Fridsma: I think the most significant thing that has come out of HHS in terms of driving interoperability are the CMS goals for the payment reform in value-based purchasing. I think that is probably the single most important thing in terms of driving towards interoperability because to do population-based health and to understand the risk that you have within your population, you’re going to have to be able to integrate lots and lots of data and you’re going to have to be able to do analytics to determine the risks. To me, that is one of the most significant things that has happened to help drive us in that direction.

Mandi Bishop: So, it’s all a business driver problem then?

Doug Fridsma: Well, it does, but it isn’t about a regulatory approach, it’s really about setting the goals and then creating a way that, not necessarily saying what we need to do, but not necessarily telling us the path to get there, because there are probably shortcuts and other ways that we, as a market, can drive things a little bit better.

David Muntz: The fact is that I would hope that the market would be the preferred choice. I think that the interesting thing about legislation is the threat that it will done. That forces the market to behave the way that it would not otherwise behave. Of course, I’m thrilled that Meaningful Use came along because it forced people to adopt technology they would not have otherwise adopted. The question is, was it done in the most effective and efficient way and were the goals actually met or will they be met is still an ongoing process?

I would hope that the private interests would prevail here and the efficiencies, the innovations and—I think what Doug said is critically important—it’s more important to set the objective and then let innovation figure out how to go down these difficult paths. I think he used the phrase “the path of least regret.”

Doug Fridsma: The path of least regret.

David Muntz: The question is can we get to the path of least regret to get us where we need to be?

The other thing I’d like to do is comment on the workflow issue. Again, when we talk about workflow, we really are focused very much on providers and the people in the business environment and what I’d like to add to workflow is the word lifeflow.

The fact is that patients don’t work at health, they live for health. If we don’t think about the patient’s role in the process of care then we won’t be doing the right thing. So, I’d like to see us add that to our vocabulary.