Dr Don Rucker on interoperability, FHIR and global collaboration

As a first year medical student in 1978, a young Donald Rucker was exposed to early health technology at his American university and knew there had to be a better way to communicate critical information.
By Lynne Minion
06:33 AM

“It struck me as how monumentally inefficient and labour intensive this environment was. It was random; innately, you could see safety issues just because it was very one-off labour intensive,” Dr Rucker told HIMSS Insights.

“I thought that automation was going to be a driving force in healthcare to make it less expensive, more efficient, more reproducible, far more safer and also, frankly, responsive to the consumer.”

But it would take many more years than he expected for healthcare to be transformed.

“I thought the EHR problem would probably be solved on Silicon Valley time in 1991 or so. So I was off by [more than] two and a half decades.”

Placing the patient at the center

Following a career of distinction as an emergency clinician and a long background as a health informatics expert and technology evangelist, Dr Rucker is now overseeing the sweeping interconnectivity of the sector as the US government’s National Coordinator for Health Information Technology. And he believes that – finally – digital transformation is poised to supercharge data sharing and hand control to patients.

“That’s what we’re striving to do – to get the public back in control of their healthcare, to have them fully informed and to get the primary location for their medical records in their possession and their control, with everything that implies about how they live their life, how they shop for care, and how they take care of themselves and their family.”

In the US, progress is being driven by technological innovation and the free market, with a boost from government policy.

“For the most part, we have consumer health apps – so things like Fitbits, jogging, diet, exercise apps – but once you get into medical care provided by doctors and hospitals there really isn’t much in terms of apps at the moment. The whole point of the Cures Act provisions is to get that to happen.”

The 21st Century Cures Act was passed in December of 2016 and requires health information vendors to provide application programming interfaces that can data share “without special effort”. Information blocking is also prohibited, with potential fines of up to $1 million.

Working to implement the law, in February the US Department of Health and Human Services (HHS) proposed new rules issued by the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS). Following a public consultation process, the final Trusted Exchange Framework and Common Agreement is expected by the end of the year.

Sharing knowledge across the globe

Now the US is sharing its insights as one of 31 nations and the World Health Organization in the Global Digital Health Partnership, an initiative started by the Australian Digital Health Agency in 2018 to exchange knowledge.

“I think it’s been helpful for the various countries to understand what each other is doing. That was the point of GDHP, and to have some learnings on things … I would say part of this is policy successes and mistakes.”

Dr Rucker said a number of countries have made good progress towards interoperability that the US can learn from too, singling out efforts in Australia, Denmark, the UK, Portugal, India and Canada.

From the US’s rich experience, the key to interoperability is standards.

“The more you can use robust standards, the more rapidly and efficiently you can do whatever interoperability you want. The power of standards is the real thing and the standard that is absolutely taking off is FHIR.”

The importance of FHIR is its elegance and simplicity, he said, which builds on technologies used in other industries and presents data in an easy to comprehend format. 

“One huge, powerful force is that the infrastructure and the fit and finish and the development tools from the rest of the economy can now be put to work in healthcare. And it’s very elegantly simple. You can look at it and understand what’s going on. It’s easy on the eyes in terms of understanding what’s going on. That’s very powerful, rather than having things that are totally unintelligible to humans.”

As a result, decades after his first experience with health IT, Dr Rucker can see an industry on the cusp of great change.

“I always was 100 per cent convinced it would happen one way or another. I think I didn’t quite anticipate starting out what the nature of that journey would be. There’s still lots of work to do, but I think you can see a couple different paths to put all the main building blocks in place,” he said.

“We have the computers, we have the networks, we have the data, we have the tools. It’s all coming together.”   

This article was first published in the latest issue of HIMSS Insights. Healthcare IT News and HIMSS Insights are HIMSS Media publications.