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Interoperability in Theory and Practice

February 21, 2011
by Jennifer Prestigiacomo
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In a conversation with Doug Fridsma, the director of Standards and Interoperability for ONC, he detailed the lessons learned from current pilots and set out a six-month roadmap for the ONC’s Direct Project.

For the past three years, the Nationwide Health Information Network (NHIN) has been creating cutting edge tools through its CONNECT project and promoting interoperability with federal partners through Direct. With pilots several states including Minnesota and Rhode Island, the Direct Project has been promoting the use of standards to share information. Most recent examples include Hennepin County Medical Center in downtown Minneapolis that has created an immunization registry, while Rhode Island has been exchanging medical consults within its small, homegrown EHR. Through these pilots and more, Fridsma realizes his team’s goals are to simplify specifications and make sure to transition the industry to a more open way of developing standards. “Simplicity matters and modularity is important,” he says. He and his team are also working on a bidirectional flow of data from federal agencies, which never have had a way to pull that data back in for analysis.

Standards Roadmap
In the next six months, the ONC seeks to refine and help evaluate Stage 1 meaningful use, as well as start preparing for Stage 2 by issuing new policies for NHIN. Three initiatives will be key to refine future standards:

1) Create custom “cables” to connect lab interfaces with EHRs and drive cost down on those interfaces
2) Standardize transitions of care by refining the vocabulary used and clinical information for physicians
3) And more long-term, simplify exchange protocols, like HL7 and CDA to make them more user friendly for adoption

HIMSS Interoperability Showcase
At this year’s HIMSS Conference, the Interoperability Showcase dominates 40,000 square feet of floor space and exhibits more than 30 use cases that illustrate the benefits of standards-based interoperable health IT solutions. I observed the inpatient medication management/medication distribution example that allowed a patient to be registered through the Interfaceware software, which then transitioned the patient information into the Epic system. Once in Epic, patient notes were populated. Then once the medication was verified by the pharmacy, it was ready to be dispensed through the Omnicell cabinet. It was fascinating seeing these systems interfacing with each other seamlessly, and especially interesting to see this when many in the industry are taking a more enterprise approach with their pharmacy and core clinical systems [see more in the upcoming April Healthcare Informatics issue about the momentum for enterprise approaches with pharmacy integration].