Interoperability has been part of the healthcare lexicon for at least a couple of decades. At some level, data liquidity has been achieved – as demonstrated annually at the IHE Connecthathon and the Interoperability Showcase at the annual HIMSS Conference & Exhibition, popular venues that always garner enthusiastic participants and audience.

But it’s still not happening at the scale we need.

Thankfully, at no other time in history has there been such a concentrated push for interoperability as there is today. Perhaps the need has become more obvious since the widespread adoption of electronic health record systems. Maybe the industry has gotten a second wind. Maybe the movers and shakers are finally impatient to make it happen. It could be simply that the stars are aligned.

Whatever the reason, interoperability is center-stage. It doesn't mean that it is done, or that the road to interoperability will be an easy ride. But, suddenly industry insiders seem more abuzz and determined to push forward.

Roadmap to interoperability

On Jan. 30, the Office of the National Coordinator for Health IT released its draft roadmap to interoperability. The document, “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0,” recommended some actions to take toward interoperability.

The "time has come for us to be more explicit about standards," National Coordinator Karen DeSalvo, MD, said in a Jan. 30 press call. The 150-page plus roadmap addresses everything from governance, standards and certification to privacy and security. "Health IT that facilitates the secure, efficient and effective sharing and use of electronic health information when and where it is needed is essential to better care, smarter spending and a healthier nation," DeSalvo said in releasing the roadmap.

The ONC invited public comment on the draft document through April 3, 2015. By the beginning of March, more than 400 comments were posted, many of them long and detailed.

Doug Fridsma MD, president and CEO of the American Medical Informatics Association, and formerly chief science officer at ONC had not yet parsed the roadmap at the beginning of March.

But, when it comes to interoperability, he's sure about many things.

"I've always relied on IEEE definition for what interoperability is," he said. "There's a broad range of different definitions for interoperability that are out there, but I've always liked the IEEE definition because it's actionable and it's measureable."

IEEE is the Institute of Electrical and Electronics Engineers. Its definition for interoperability is in two parts.

"It's the ability of two or more systems to exchange information," Fridsma said. "That's the first part. The second part is the ability of the systems to use the information that's been exchanged."

Interoperability is defined as exchange and use. Exchange without use – without being able to achieve what you want to achieve with the exchange of information, is not interoperability, in his view.

"The thing that's nice about that particular definition," as Fridsma sees it, "is it means that you have to define interoperability in terms of this thing that you want to do."

"So exchange and use," Fridsma said. "And if you define the use in measureable ways, you can actually start measuring the progress that you're making toward interoperability."

So, you think measurable is really important? "I do," he said. "Because you can't improve the things you can't measure."

Fridsma also advocates getting very clear on what it is the nation wants to achieve with regards to interoperability. "We have to be very specific about what that is," he stressed, adding that since the "P" in HIPAA stands for "portability," one of the goals might be for patients to have truly portable electronic health records that can move from one system to another.

"You know, it can be exported from one and imported into another," he said. "That may be a very laudable goal – and it's measurable."