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Stage 2 Meaningful Use: Surfing the Waves of Interoperability, Part II

by Jitin Asnaani, Director of Technology Standards and Policy

In my last post , I discussed the ways Stage 2 Meaningful Use is facilitating industry-wide clinical interoperability, and alluded to “waves” of interoperability that promise to finally connect millions of patients, caregivers, payers, provider networks, entrepreneurs and technology innovators. Let’s get into more detail about those “waves,” and how they are poised to change health care as we know it.

Standards development on the heels of Stage 2

In several instances, Stage 2 requirements adopted standards that precipitated from the Standards and Interoperability (S&I) Framework, a crowd-sourcing forum for health information exchange (HIE) standards kick-started by the Office of the National Coordinator (ONC). Even though Stage 2 standards work is complete, the S&I Framework continues to attract communities of innovators aiming to establish standards for other popular health care use cases—their initiatives will drive the first wave of interoperability. Most notable among them:

  1. Lab Orders Interface (LOI): Aims to standardize the content and structure of lab order messages sent from electronic health records (EHRs) to laboratory information systems (LISs). This creates a powerful combination with the Lab Results Interface (LRI) standard required for Stage 2, enabling standardized transactions that “close the loop” between providers and labs.
  2. Blue Button Plus: Aims to enable consumers to exercise more access to, and portability of, their health care information, by combining clinical document standards with secure transmission protocols.
  3. Query Health and Data Access Framework initiatives: Focuses on “query-based” interoperability, enabling providers to request information from their health care community and receive responses.

Expect the outputs of some of these initiatives to find their way into Stage 3 Meaningful Use regulations, which will add impetus to the wave. But even while this wave brews, recall that the S&I Framework has always worked in tandem with existing Standards Development Organizations (SDOs) who have been building standards for decades, such as Health Level Seven International (HL7), and Integrating the Healthcare Enterprise (IHE). Thanks to the partnership with S&I Framework, these organizations are re-inventing themselves, creating a second, distinct wave of interoperability by driving new programs that focus on tackling the national challenges surfaced by ONC and the S&I Framework community.

In particular, HL7’s Fast Health Interoperability Resources (FHIR, pronounced “fire”) initiative is very likely to have a dramatic impact. FHIR promises to finally break that outdated, de facto paradigm that “every exchange of information requires a document” – and usually a complicated, heavyweight document, at that – and supplant it with the concept of granular self-contained “molecules of information.” The beauty of this approach is not just simplicity, but flexibility as well, because small pieces of information can be transmitted in a variety of modern ways.

This idea is big. Very big. To illustrate its magnitude, here’s a thought exercise outside of health care: What if the only way you could share electronic information with others was through PDFs or Word Documents that contained all our information at once? What would the Internet browsing experience be like? What would mobile banking look like? Would we have ever have Facebook, Twitter, Mint, or mobile apps? It seems completely insensible in a big document-centric world—yet that’s how we’ve constrained health information exchange today.

In my third and final post in this Meaningful Use interoperability series, I’ll breakdown the three final ‘waves:’ collaboration amongst competitors, population health management and disruption. Look for that post to follow in the coming weeks.

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