Dr. David Blumenthal, director of the Office of the National Coordinator (ONC) for Health Information Technology, recently urged the healthcare industry to break down barriers to electronic exchange of healthcare information in order to improve the quality of care and better serve patients.

To reach that goal, we must develop a greater degree of interoperability among healthcare IT applications than we have today. To discard the existing data interchange standards and to replace them with something new and "simpler," as some are proposing, would be counterproductive.

Instead, we need updated and simplified tools and processes that leverage the existing standards and produce the needed interoperability. Specifically, the HITECH legislation requires the reuse of data for decision support and for quality evaluation.

Within the Office of the National Coordinator, the Federal Health Architecture (FHA) group is exploiting the flexibility of those standards in order to connect the information systems of more than 20 federal agencies. These systems encompass the payer system, the provider sector and the public health services.

These agencies, like nearly all hospitals and healthcare systems in the U.S., make extensive use of Health Level Seven (HL7) standards for most internal administrative and clinical messaging. Likewise, they use other related standards for drug prescribing (NCPDP), imaging data (DICOM), and billing-related information (X.12).

Rather than demanding that these government agencies replace their extensive IT systems that were developed to use the existing standards—a prohibitively expensive project—the FHA is using an overarching peer-to-peer approach. In addition, the FHA has provided open source CONNECT middleware, in order to seamlessly exchange vital patient and research data generated by the different federal agencies.

The cornerstone of this approach is to reconcile existing implemented data, messaging and electronic document standards, even in cases where those standards have been adapted to meet the unique needs of individual agencies. The addition of well-engineered middleware to enable communication with Health Information Exchanges will facilitate the exchange of data with the participating agencies and to connect with the Nationwide Health Information Network (NHIN).

The FHA has invited outside programmers to help write portions of this code, which is open and free to all. But the overriding goal of the FHA is to design a unified architecture that uses one vocabulary, one toolkit, one process for building exchange interfaces, and one method of connecting all of these agencies. None of this would be possible without the underlying standards, such as those of HL7, NCPDP, X.12 and DICOM.

Another FHA priority is to help federal agencies, such as the Department of Veterans Affairs and the Military Health System, satisfy the criteria that the Department of Health and Human Services (HHS) is developing for the "meaningful use" of Electronic Health Record systems.

Although private sector organizations hope to obtain HITECH funding for attaining meaningful use objectives, the federal agencies will develop landmarks to spur innovation.

One example of the FHA demonstration projects is the development of computerized physician order entry (CPOE) systems. Both the Military Health System and the VA already use CPOE, but they are looking to the FHA to develop better methods of exchanging patient level data between agencies.

In 2013, these agencies, along with the non-federal health provider industry, will be obliged to successfully implement computerized decision support tools. Even more demanding are the requirements for 2015, in which all providers must provide data for quality evaluation as well as demonstrate improved outcomes.

Other federal agencies are already using existing health IT standards in a variety of ways. For example, the Centers for Disease Control (CDC) sends state and local health agencies tens of thousands of documents daily that conform to HL7's Clinical Document Architecture (CDA). The VA system, the National Institutes of Health (NIH), and the Food and Drug Administration (FDA) also routinely exploit the advantages of CDA document exchange and the FDA will soon require pharmaceutical companies to implement CDA for regulatory submissions. The ONC HIT Standards Committee has also recommended that by 2013, CDA be implemented for exchanging clinical information.

Moving forward, the FDA will leverage existing standards and adopt addition standards that are mandated by ONC. By and large, the major vendors continue to support this approach, as it moves us closer to true interoperability and to significant improvement in patient care.

-- Dr. Charles Jaffe is chief executive officer Health Level Seven. 
-- John Quinn is chief technology officer of Health Level Seven.