Achieving interoperability is a ‘shared responsibility,’ says national coordinator for health IT


Interoperability was one of the most talked about topics throughout HIMSS 2013 Annual Conference and Exhibition last week. The Interoperability Showcase proved to be as popular as ever with many use cases on display, recurring tours and speakers slated every half hour. There was also the recent announcement that interoperability testing would occur year-round at HIMSS Innovation Center in Cleveland. At the conference, six EHR vendors staged a news conference to spotlight their commitment to interoperability with the formation of the CommonWell Health Alliance.

Before heading to New Orleans for the HIMSS13, Healthcare IT News asked ONC chief Farzad Mostashari, MD, for his take on interoperability, and what it would take to achieve it sooner rather than later.

Q. Talk about the lack of interoperability: What has to happen to change it? Does it have to come from the vendors?

A. Most vendors really do see it now as part of their self-interest to be as interoperable as possible, but we still hear a lot of complaints from providers that their vendors are putting up what they believe are artificial roadblocks to them being able to share information, to participate in health information exchange.

It’s a shared responsibility. Fundamentally, we have to reduce the cost and complexity of interfaces through standards and implementation guides. The vendors have to really be able to do Stage 2. It’s a huge step up – huge step up on interoperability. Vendors are really going to have to step up to the plate in terms of being able to achieve the Stage 2 expectations for true vendor-to-vendor coded, clinical structured, documents being able to have kind of ubiquitous protocols with security in place. That’s a big step for the industry and meaningful use Stage 2 sets the tempo and expectations for that.

Q. Apparently you believe that will happen?

A. I think it’s not going to happen by itself. It’s going to need a lot of work on the part of the vendors, but also for us to help provide examples, tools forums, education. This is the year where implementation happens for Stage 2 – getting ready.

Governance is also a piece of that. We decided against a regulatory approach to governance. But that means, again, these public-private groups need to step up and create the common rules of the road that people will voluntarily adhere to, and common approaches. So that is also a work in progress and something we have to push hard on to get to that kind of trust.

And the customers have to be demanding of interoperability of their existing vendors and particularly when they’re thinking about purchasing new systems or replacing their system. If the system does not interoperate, and if the vendor doesn’t seem committed to interoperability, you should look elsewhere, because the future of healthcare is going to be the need to coordinate.

Q. Some say interoperability is a decade away. What do you think?

A. Interoperability, as Doug Fridsma (director of ONC’s Office of Science and Technology) says, is not a destination, it’s a journey, in the sense that it’s constantly evolving. There’s always going to be new needs, new requirements for interoperability. We’re going to constantly have to keep stepping up towards greater and greater levels of being able to share information and understand the information once it’s shared.

I believe that we have made more progress in the past two years on interoperability, motivated by the meaningful use incentive program and by collaboration and the open inclusive process to get to consensus than the decade before. I think Stage 2 is going to be a big step up. We also have a lot of irons in the fire around query-based transactions, around query health and many other S&I (Standards & Interoperability Framework) initiatives that are going to bear fruit – no not in 10 years, in the nearer term.


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