In a session on the Office of the National Coordinator for Health IT's strategy for achieving interoperability at AHIMA on Monday, Chief Science Officer Doug Fridsma laid out the agency's goals surrounding meaningful use and what Fridsma called "the Learning Healthcare System."
The Learning Healthcare System, according to Fridsma, is a framework in which every interaction in the industry creates an opportunity to care for patients better.
"I want a world in which every encounter with healthcare systems and with your health is an opportunity to learn how to do it better," Fridsma said.
That framework encompasses a scale of engagement and a series of fundamental "building blocks" of health IT systems. The scale of engagement, which covers the relationship between patient and practice, practice and population and population and pubic, creates a feedback loop that determines quality of care, public health and clinical research in one direction and clinical guidelines, public health policy and clinical decision support in the other.
The building blocks, Fridsma said, will be present in the Federal Health IT Strategy, due out in the winter of 2014. They include:
Interoperability of standards and services: "The way we capture information for patients should be similar to how we manage them," Fridsma said.
Certification of health IT to accelerate interoperability: "We have tested that when we say a system works a certain way, it does," Fridsma said. "We don't just adopt standards but we ensure we are using them."
Privacy and security protections: "Information moving around this ecosystem will only move as fast as the speed of trust," Fridsma said. "If you don’t trust who you’re sharing info with, you won't share it."
Supportive business, clinical and regulatory environments: According to Fridsma, this is the pillar that ensures the incentives are lined up to reward interoperability.
The goal, for Fridsma, is to develop a healthcare system in which interoperability is the norm. Fridsma emphasized the importance of a standardization of the term, which he defined as the ability to exchange information and the ability to use the information that has been exchanged.
"Some people say ONC got the cart before the horse because we adopted EHRs before we had interoperability," Fridsma said. "But I firmly believe we can't develop interoperability in a vacuum. The only way we get to interoperability is by exchange and use."
The ONC's role in assisting that interoperability will be to leverage government as a platform for innovation to create conditions of interoperability; create a portfolio of solutions that support a variety of uses and users (rather than attempt to be "one size fits all"); and build advancements in incremental steps.
Fridsma also emphasized the importance of industry standardization as a pathway to interoperability. There are five key areas that need to be defined across the industry, according to Fridsma:
Vocabulary and Code Sets: How would well-defined values be coded so that they are universally understood. This will allow for semantic interoperability.
Content structure: How should the message be formatted so that it is computable? This will allow for syntactic interoperability.
Transport: How does the message move from A to B? This will create information exchange.
Security: How can the industry ensure that messages are secure and private?
Services: How do health information exchange participants find each other?
The agency is also currently working to develop a detailed interoperability "roadmap" this year, with three, six and 10-year goals.