HL7 – not just for IT anymore. That thinking is the catalyst behind a triptych of recent moves designed to open the standards process to more health professionals, notably caregivers.

Ideally, pulling in a new group of professionals will open the feedback loop, particularly to those concerned with usability and workflow, but by no means limited to that. According to Charles Jaffe, MD, HL7 CEO, tapping into their minds and, indeed, day-to-day work experiences will also yield specialist knowledge that bolsters decision support.

Jaffe discusses those initiatives, positive initial reactions, and what the future holds for HL7. Hint: Genomics, and mobile health.

Q: I’ll start by asking about HL7 recently opening up some of your intellectual property to the caregiver community…
A: We are going to make immediately available, at a nominal charge, a caregiver membership for health professionals – including physicians, nurses, therapists and pharmacists. This is intended to broaden the base of HL7 and to increase domain expertise. Hopefully, a small percentage of them will actually become involved in the development of standards. We expect contributions to usability, workflow, so on and so forth.

Q: So what’s the end-goal of this broadening?
A: It certainly is in our interest to bring in a new group of members. We believe that their interest stems from their concern about usability, workflow, and domain content. A simple example is that of a pediatrician, needing an electronic health record that more accurately reflects the specific needs for caring for children. So would the allergist and immunologist, because there are lists of things that glibly are referred to as allergy, which really fall into the category of ‘I think I don't like this medicine.’ The allergy community is dismayed that they have so little to say in the development of this important component of the EHR.

Q: Any other communities with a similar sentiment?
A: This lack of precision leads to the publication of articles that conclude that ‘EMRs are not effective.’ So if electronic medical records are simply a substitute for paper, then there’s probably little benefit, other than you can read it. But if the definition of electronic medical record embraces decision-support, I would expect to see demonstration of the clear benefits of electronic medical records. Decision support would truly enable the clinician to provide care that is both higher in quality and lower in cost.

Q: You’re talking about decision support based on a variety of specialties?
A: If we were to have allergists and immunologists participate in the process, we would help improve the content, the workflow, the business rules for an electronic medical record. This is equally true for other diseases, other specialists, other verticals, in which caregivers are able to contribute and improve disease management.

At some point, we will have medical records with well-embedded decision-support as part of their functionality. HL7 has been focused on this for well over a decade. It’s difficult, it’s expensive, and you need reliable content that can be codified. We need standards for integrating that content into workflow. We need better algorithms, we need better decision support and we want the caregivers to participate.

Our decision to make the IP free, our decision to embrace a larger stakeholder community beyond the IT and technical folks, is critical to this process. We hope to bring in the individuals with knowledge of the workflow and the content, in order to review our profiles and our domain models. Those two announcements really went hand-in-glove.

Q: The first one was opening up the IP to caregivers, the second being late last month you made EHR domain models available for no-cost licensing. Is the recent announcement that you are connecting HL7 CDA to clinical trials data also a piece of that puzzle, or something else entirely?
A: At HL7 we have a domain model called BRIDG (Biomedical Research Integrated Domain Group), in which we have modeled clinical research into the larger domain of medicine and so one terminology, one exchange language, and so forth. This is a long-standing collaborative effort between CDISC (Clinical Data Interchange Standards Consortium) and the National Institutes of Health and HL7, and a very successful one. So that’s not a new interest. We have other vehicles to bring the research community into the organization.

Q: And has anybody started participating in that?
A: Yes. As a matter-of-fact, after only a week, we have had more than 200 people download the profile. I spoke at a meeting this weekend and we had two-dozen clinicians inquire about how to log on and join as HL7 caregiver members. American College of Physicians, while they want to learn from us, we also want them to influence our development process.

Q: Building on the caregiver initiative, the EHR domain models, what’s on the horizon for HL7?
A: This project to make the intellectual property cost-free to the user is just a pilot. We will evaluate the success of the program, the implications to our business model, and we may expand it to more HL7 intellectual property. At the same time we’re expanding some of other key programs. In the not-too-distant future, for example, your genetic profile will help guide the caregiver in both diagnosis and treatment. We have a large genetics and genomics workgroup that is developing the specifications that enable the integration of genomic data into the patient record in a seamless, uniform fashion
We also have a new workgroup interest in mobile health. We have had numerous inquiries about the standards that are needed for delivery of content securely in a mobile environment. In addition to the delivery of data, mobile systems are a means of providing decision support. If clinicians are able to have a mobile device at the point of care, they might be able to incorporate decision support into their workflow. We think mobility is a key issue and we’re jumping in with both feet.