HIMSS: Standards & interoperability framework developing, needs input
ORLANDO, Fla.--Standards of interoperability are needed because whitepapers are not specifications, said Doug Fridsma, MD, PhD, director at the Office of Interoperability & Standards at the Office of the National Coordinator for Health IT (ONC) Feb. 22 during the 2011 Healthcare Information and Management Systems Society (HIMSS) conference.

“That means we can describe how we want interoperability to occur, but if we have a whole series of documents on how to represent healthcare organizations or patients, it can become quite unmanageable working across all the documents to stay consistent.”

During the “ONC Standards & Implementation Framework Townhall” meeting, Fridsma outlined his work and shared information on some initiatives working towards a Standards & Interoperability Framework, a set of integrated functions, processes and tools being guided by the healthcare and technology industry to achieve harmonized interoperability for healthcare.

The framework’s mission is to promote a sustainable ecosystem that drives increasing interoperability and standards adoption while creating a collaborative, coordinated incremental standards process that is led by the health IT industry in solving real-world problems, according to Fridsma. “One example of this is the Direct Project,” he said, adding that it was established after the industry responded to the project with constructive criticism. “We want to continue that way in getting [stakeholders] engaged.”

Fridsma additionally stated another goal of the framework is to leverage “government as a platform” to provide tools, coordination and harmonization that will support interested parties as they develop tools to interoperability and standards adoption. “[We have] to make sure we have coordination as we think about private and public sectors communicating [into the future].”

The Office of Interoperability & Standards wants to move toward more computational implementation specifications, including scalable processes and the ability to develop tools to increase the efficiency of information systems development and maintenance, said Fridsma.

“This means thinking about certification and testing at the very beginning of the process,” he stated.

To develop the framework, ONC needs to help integrate multiple standards development organizations (SDOs) within different enterprises across the process; a task that will include integrating transport packages, vocabulary and value sets. Fridsma also noted that the government will need to help provide repeatable mechanisms for harmonization and integration of existing standards across SDOs.

“This is not a waterfall process,” said Fridsma. “Developing and harmonizing standards and service specifications across diverse communities necessitates concurrent, agile activities.”

As for organizational principles for the Standards & Interoperability Framework, Fridsma stated that to play the futures market and manage the coordination of these concurrent activities within the framework, artifacts, roles and control points need to be well-defined.

“We need to ensure the content and structure of the artifacts ... provide continuity within the activities and the tools,” he said, adding that clear “ownership” of significant artifacts and activities need to be understood.

Fridsma admitted that a bottom-up use case development within a top-down coordination framework “is a tough goal.”

“We must be clear what the initiatives are and what their targets are and remind people of those targets. Otherwise, people can get caught in the weeds.”

Specific health interoperability initiatives guide the design and development of a fully integrated and connected health information system. Fridsma shared some information relating to recently launched initiatives that focus on challenges with a set of value-creating goals and outcomes for the development of content, technical specifications and reusable tools and services.

Mentioning that the initiatives are in “forming and storming stages,” Fridsma offered the following:
  • Transition of Care – Launched Jan. 7 to support meaningful use Stage 1 requirements for exchange of data during transitions of care. “As we look toward accountable care organizations and the like, we need standards for transition of care,” he remarked. This initiative is to enable clinical summary validation services to ensure providers can understand information. Piloting and testing is to be completed by September.
  • Lab Interface – Launched Jan. 7 to standardize how to incorporate lab results into EHR as structured data. Goals of this project include attempting to reduce total lab interface implementation time by 20 percent by 2013. Piloting and testing is to be completed by September.
  • Consolidation Project – Launched Jan. 4 in an effort to consolidate the implementation guides across the Health Story, Indiana Health Information Exchange and HL7 to harmonize and consolidate current CDDA in order to ease implementation challenges. Piloting and testing is to be completed by October.

“Don’t let ‘perfect’ be the enemy of 'good',” Fridsma concluded. “Start small to solve important things that are getting in the way [of interoperability]. That way [we can push gradually towards] incremental, iterative and value-focused [standards].”

As an open government initiative, the Standards & Implementation Framework benefits from public input and participation.