Joyce Sensmeier, RN, HIMSS vice president of informatics, agrees that in discussing interoperability it's critical to keep the patient front and center – and care providers, too. She said the roadmap addresses this well.

"One of the challenges I've seen over the last couple years is really we focused on the technical aspect of interoperability – we as an industry in general," she said. "And, while, of course that's an important part, I think we've missed out on thinking about the providers, the individual clinicians as well as the organizations.

"It starts with them," she added. "For example, a clinician working with a patient, documenting their care, and then capturing that into the record, and then having that record be the source of truth, so to speak, for that data – and having that data accessible wherever that patient goes. To me, interoperability begins with that – and it ends with that."

"We have not talked much about the patient," Sensmeier said. "We get busy trying to solve those tough technical problems and forget about the fact that there's an important component of the patient and the providers."

That may be so, but five Republican senators recently criticized the draft roadmap for being too general and missing 'nitty-gritty technology specifics."

"We have been candid about the key reason for the lackluster performance of this stimulus program: the lack of progress toward interoperability," Sens. John Thune of South Dakota, Lamar Alexander of Tennessee, Pat Roberts of Kansas, Richard Burr of North Carolina and Mike Enzi of Wyoming, wrote in a March 4 Health Affairs blog.

IHE and FHIR
Meanwhile a number of groups are working on various aspects of interoperability. One that seems to have caught the imagination of many in the industry is FHIR. It's pronounced "fire," and it stands for Fast Healthcare Interoperability Resources.

Charles Jaffe, MD, CEO of standards organization HL7, is an avid proponent.

As Jaffe described it in an Oct. 17 interview with Healthcare IT News, "FHIR represents a departure from the notion of messaging and document-centric ideas."

"FHIR is such a significant advance in accessing data, delivering data and the enormous, enormous flexibility inherent in the model," he adds. FHIR doesn't specify the content; FHIR specifies what we mean by the content."

He describes FHIR as a platform and a set of rules.

It originated with interoperability consultant and developer Grahame, Grieve, of Melbourne, Australia. Grieve sits on several HL7 committees.

John Halamka, MD, CIO of Beth Israel Deaconess Medical Center in Boston, is a fan of FHIR and the Argonaut project.

"It’s a perfect storm for innovation when stakeholders, resources, and political will align," he wrote in his Dec. 4, 2014 blog. "The Argonaut Project is a great example of policy and technology solving real problems in a reasonable timeframe driven by the value proposition that interoperability via open standards benefits all."

Sensmeier, though, is more circumspect. She started the Connectathon more than a dozen years ago. Also, the growing and popular Interoperability Showcase at the annual HIMSS conference – now evolved far beyond what anyone first envisioned – was her brainchild. She's earned her interoperability stripes.

She is cautious when it comes to FHIR, noting that the testing under way is not as advanced as the testing conducted at the Connectathons. FHIR testing is more akin to a hackathon, she said. Sensmeier is partial to the IHE framework she developed more than a decade ago. IHE stands for Integrating the Healthcare Enterprise. IHE has proven its rigor at one Connectathon after another over more than a decade, she noted.

"Those are very important efforts," Sensmeier said of FHIR, "but they're beginning efforts, and FHIR is not a mature standard. We need to build our infrastructure on mature things that we know work. That said, of course, we still want to look at innovation and what's coming down the pike. So, I put FHIR and the Argonaut Project in that category."

Meanwhile the Argonaut Project – a collaborative created by HL7 and joined by Epic, Cerner, MEDITECH, Mayo Clinic, Intermountain Healthcare, Partners HealthCare and several other marquee vendors and providers – is at work on ways to speed the development and adoption of FHIR to push interoperability forward.

This article first appeared in the April 2015 print issue of Healthcare IT News.