Case Study "Enabling Data Interoperability through the Healthcare Continuum” Charles Jaffe, MD CEO Health Level 7 (HL7) iHT2 case studies and presentations illustrate challenges, successes and various factors in the outcomes of numerous types of health IT implementations. They are interactive and dynamic sessions providing opportunity for dialogue, debate and exchanging ideas and best practices. This session will be presented by a thought leader in the provider, payer or government space.

1. Enabling Interoperability
Charles Jaffe, MD, PhD
CEO, Health Level 7
Professor of Medicine, UCSD
iHT2 HIT Summit
Austin
11December 2013

2. CME Disclaimer:
I don’t sell anything. Almost anything
you may want from me
is free.

3. Why would the conference producers
place a presentation
on standards
right before lunch?

4. Best Guess:
Because HL7 standards are the
cornerstone of
Meaningful Use 2
and will be even more critical in
Meaningful Use 3.

5. Next Best Guess:
Because HL7 standards are the
only real hope of ever
achieving Interoperability.

6. Why is Interoperability so hard?

7. I guess it depends upon what
you mean by
Interoperability.

8. Semantic Interoperability means
the ability of two machines to
exchange data,
and
to reuse the data that has
been exchanged.

9. There are other kinds of
Interoperability,
but if you want to get to
Plug-and-Play Interoperability
then it’s even harder.

10. “All you need in this life is
ignorance and confidence,
and then success is sure.”
Mark Twain

11. Reasons why Plug-and-Play
Interoperability is so difficult:
Too many standards.

12. Too many standards.
The last time I’m certain that
the US got it right was 1861.
The government mandated
one gauge of track for the
Continental Railroad.

13. Too many standards.
The Australian rail system
has 3 gauges of track.

14. “If you can't be a good
example, then you'll just have
to serve as a
horrible warning.”
Catherine Aird

15. Too many standards.
Electric plugs.
Is any further explanation needed?

16. Too many competing standards.
Genomics
The rule of Not Invented Here

17. Reasons why Plug-and-Play
Interoperability is so difficult:
Too few standards.

18. “Knowledge is knowing that a
tomato is a fruit.
Wisdom is not putting
tomatoes in a fruit salad.”
Peter Kay

19. Standards too difficult to
understand,
apply,
manage, or
implement

20. Healthcare is difficult.
Data Elements needed for an
ATM: 10

21. Healthcare is difficult.
Unique English words:
450,000*
* I would not like to debate the exact figure.

22. Healthcare is difficult.
Unique terms in the
National Library of Medicine
Metathesaurus:
2.4 Million

23. (Sometimes) Government
Regulatory Agencies
make things more difficult
than necessary.

24. What is this?

25. Sorry, EC Regulation says this is
not a banana.
European Commission Regulation No. 2257/94:
bananas must be "free from malformation or abnormal
curvature“
European Commission Regulation No. 1677/88:
bananas are allowed a bend of 10mm per 10cm of length

26. “If the Federal Government
were put in charge of the
Sahara Desert,
in five years we would
run out of sand.”
Milton Friedman
American Economist

27. Some standards are
too flexible.

28. Too flexible:
HL7 Version 2
dreaded Z-segment.

29. One solution: Postel’s Principle
Send conservatively.
Receive liberally.

30. Some standards are
not flexible enough.

31. Not flexible:
The list is too long.

32. “How much easier it is to be
critical than correct.”
Benjamin Disraeli

33. Some standards are
difficult (impossible)
for humans to use.

34. Hard for humans to use:
ICD-10
Impossible for humans to use:
ICD-11

35. Some standards are
interpreted
differently by different folks.

36. HTML 4
How many web browsers do you
need to use?

37. Some standards are
implemented
differently by different folks.

38. Same answer.*
* Each web site has a different idea what
HTML 4 requires.

39. “To be sure of hitting the target,
shoot first, and call whatever
you hit the target.”
Ashleigh Brilliant

40. Well, what does HL7
actually do?

41. HL7 doesn't
write software.

42. We make
writing software
more intuitive.

43. HL7 doesn't provide
care for patients.

44. We make caring
for patients
safer.

45. HL7 doesn't
do clinical research.

46. We make
doing clinical research
more effective.

47. HL7 doesn't
pay for healthcare.

48. We make
paying for healthcare
less costly.

49. HL7
is developing standards that
will change the way we
exchange,
analyze,
and reuse
healthcare data.

50. Here are
3
of them.

51. CDA: Clinical
Document Architecture

52. Think of CDA as an envelope
Mayo Clinic
Department of Immunology
200 1st St SW
Rochester, MN 55905
Charles Jaffe, MD
Department of Medicine
University of California
La Jolla, CA 92037
in which you can put any document,
like a report or EKG or image.

53. Characteristics of CDA Documents
• Securely identified
• Unaltered document formatting
• Machine processable
• Human readable
• Combined structured data & free text
• Easily mined for complex data signals
• Scalable for both text & large image files

54. The very modular nature
of CDA makes interoperability
faster,
easier,
and cheaper.

55. Consolidated-CDA
is the keystone to bridging
from MU 2 to MU3

56. Some Current Applications of CDA
• Public Health reporting
• Clinical Decision Support
• Regulatory submissions for Clinical Trials
• Quality Measures
• ePrescribing
• Personal Health Records
• Procedure reports & Operative notes

57. New releases of
CDA
will fundamentally
change
how documents
are exchanged

58. For terabyte instances of
big data analytics,
CDA has proven both scalable & reliable

59. Trifolia
A portfolio of tools
for storage, curation, retrieval, archiving
and creation of templates for CDA,
built with a unique
template exchange language.

60. FHIR
Fast Healthcare Interoperability
Resources

61. FHIR
A framework for the development of
data exchange technology that offers
the interoperability of the RIM, while
hiding the complexity of V3

62. What makes FHIR fast?
Faster to learn
Faster to develop
Faster to implement
FHIR

63. A gentle word of caution about FHIR
Current Status
The
Gartner
Hype
Cycle
2015-2016

64. FHIR
Enables
Mobile Health

65. CommonWell
Embraces
FHIR

66. BRIDG
Model

67. BRIDG Model
• Biomedical Research Integrated
Domain Group
• A domain analysis model of the
HL7 RIM
• Seamlessly integrates patient care
and clinical research data
• Integrates with regulatory submission
processes
• Supports the Learning Health System

68. HL7
is more than
standards

69. HL7
is about
implementation

70. If it couldn’t get any more
overwhelming,
I’ll try to describe
15 new Implementation Programs
in the next 5 minutes.*
* No, you don’t have to take notes.
I’ll give you these slides.

71. Help Desk

72. HL7 User
Groups

73. International Healthcare IT Policy

74. Health
Professionals
Group

75. EMR
Functional
Model

76. Longitudinal
PHR
Functional
Model

77. Blue Button
Veterans Administration
HL7
Blue Cross

78. Mobile Health

79. Privacy
& Security

80. Claims &
Claims Attachments

81. Genomics

82. Healthcare Quality
Measures
& Reporting

83. Conformance Testing
& Certification

84. Conformance Testing
& Certification
• ISO 17025 Testing & Certification partners
• Iterative, not once-and-done
• Not a Connectathon model
• Asynchronous – 7/24
• Process improvement focused

85. Education Services

86. HL7 Education Portal
•
•
•
•
eLearning Program
HL7 Competency Certification
Webinar series
Education Summits

87. Vocabulary
Authority

88. If you haven’t had enough
Interoperability
for one morning, try…
www.HL7.org

89. Thanks
cjaffe@hl7.org