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ONC's Doug Fridsma Pushes the Envelope on Interoperability

February 23, 2014
by Rajiv Leventhal
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At the Healthcare Information and Management Systems Society (HIMSS) annual conference in Orlando, Fla., Doug Fridsma, M.D., Ph.D., chief science officer and director of the office of science and technology in the Office of the National Coordinator for Health Information Technology (ONC), presented on the national goals and priorities concerning interoperability. 

As part of a Feb. 23 pre-conference symposium called, "The Interoperability Explosion: Where We Are and Where We’re Headed," Fridsma described the U.S. roadmap for achieving interoperability as well as key milestones achieved in the meaningful use Stages 1 and 2 to promote and accomplish medical data interoperability.
Fridsma explained how the stages of meaningful use act as a vehicle to accomplish healthcare's Triple Aim. Meaningful use centers around adopting electronic health record (EHR) technology, exchanging information to make it useful, and improving outcomes, he said. "And embedded in that is interoperability. You can't talk about the interoperability of a paper record," Fridsma said. 
To that end, Fridsma outlined ONC's interoperability strategy, including its five pillars to achieve true interoperability. First, said Fridsma, is the meaningful adoption of EHRs. Second is developing appropriate standards and certification. Third, continued Fridsma, is ensuring privacy and security of all data. Fourth is encouraging the appropriate business and clinical incentives. And finally, Fridsma said, is having proper gorvernance to support transparent exchange and ongoing access for all patients and providers.
Digging deeper, Fridsma said the focus must be on supporting success of meaningful use, continuing to expand the value of accountable care organizations (ACOs), payment reform, DoD/VA system acquisitions and other administrative priorities, and modernizing ONC's standards portfolio to take advntage of newer simpler and more powerful standards.
"We don't want to get ourselves anchored in how we started," Fridsma said. "Ten years from now, there will be  new technology and new ways to how we do things. We need to continue to look to the future and migrate, or we will get stuck in a rut."
And while it is the job of ONC to make sure that others in this space succeed, it needs to be done in incremental steps, Fridsma advised. "We will never develop interoperability solutions in a committee, hearing, or pilot. We will do it in the real world, though. Don't let the perfect become the enemy of the good. Our job doesn't become developing a health information technology  infrastructure—that's your job (speaking to the audience)—but instead have a portfolio of standards that will allow us to move forward," he said. 
This portfolio can't predict the future, but it will build and refine standards, said Fridsma. Included in this portfolio are: a standardized meaning through vocabularies and terminologies, so one computer understands what the other one says; a standardized structure so a computer can start at the beginning a of file and get to the end without it breaking; a standardized transport for how information is moved around; a standardized security so encryption  and decryption  works; and standardized services, as the entire internet runs on four different application programming interfaces (APIs), Fridsma said. 
"But we won't get there by working alone," he said. "The Standards and Interoperability (S&I) Framework [a collaborative community of participants focused on facilitating the exchange of health data] is how we will solve challenges and get to where we want to be. S&I is an example of government as a platform, getting people with the same problems to come together for collective solutions." 
According to Fridsma, participation and process of the S&I framework include 2,980 wiki (which includes all current content and ongoing discussion that takes place in the S&I framework community) registrants, 757 committed members, 580 committed organizations, and nearly 4,000 (out of 5,000) HL7 ballot comments resolved. 
The future, said Fridsma, is about creating a learning healthcare system where patients being engaged provide an opportunity to learn about those patients. "We need to use data to improve public and patient health," he said. "What we measure  needs to become actionable so we can improve."