Interoperability is 'impossible in the abstract'

True interoperablity must be 'actionable,' and 'will have be driven by market forces'
By Mike Miliard
11:14 AM
Doug Fridsma, MD

"I'd like to see a world where you get paid because you have good informaticians," said Doug Fridsma, MD, former chief scientist at ONC and now CEO of AMIA, speaking Wednesday at RSNA's 100th annual meeting in Chicago.

[See also: Public APIs getting ready for prime time]

The key to making that world a reality, of course, is enabling the free flow of information of all types – from lab results to medications to imaging data – within and between healthcare organizations of all shapes and sizes.

Widespread interoperability has been elusive so far, but ONC has been working on an expansive 10-year roadmap pointing the way toward full-on data liquidity, from sea to shining sea. In the meantime, there's a lot of hard work to do.

[See also: Interoperability 'taking so darn long']

"There is this focus on the high-level strategies, and that's going to be important," said Fridsma, who stepped down from the agency this fall after five years coordinating its approach to standards, interoperability and health information exchange.

But in the near term, he said, it was crucial to focus on achievable goals.

"Interoperability is hard in the concrete; it is impossible in the abstract," he said.

"The roadmap will help us," said Fridsma. "The challenge will be to make it actionable, to make it concrete. We have to make sure what we do is grounded in real things that we want to accomplish."

It's going to take a team effort, on both sides of the public/private divide.

Fridsma isn't the only official to leave ONC in recent months. That staff exodus, coupled with other questions about the agency's budget and mandate – not to mention yet another pivotal and potentially landscape-shifting election in 2016 –  mean challenges for the agency "at a critical time when a lot of things are coming down the pike," he said.

The federal health IT strategy is what it is, but "we need the private sector to step up and do a lot more of this," said Fridsma. "Private sector engagement is going to be critical."



Stage 1 meaningful use was successful in spurring IT adoption. Stage 2 has proven much more challenging in its efforts to drive data exchange.

Stage 3, said Fridsma, "is unlikely to push the envelope too far," he said. Not only is there less federal money around to help force the issue, but "there is real fatigue" among providers and vendors grappling with a slew of new rules from an alphabet soup of government agencies.

"This is hard. We've been going in these 18- and 24-month cycles, which is quite tiring for the vendors and the doctors and, quite frankly, for the federal personnel."

So, he said, "the private sector needs to lead. Interoperablity will have be driven by market forces," and not through regulatory fiat.

He's seeing encouraging signs. For instance, "new standards coming from HL7, driven by industry, that have a lot of potential."

At any rate, said Fridsma, even if the will and the wherewithal were there from the feds, too much regulation is counter-productive.

"I think it would be a mistake for us to have overly-regulated interfaces, particularly if we're thinking about driving innovation in this space," he said – pointing to a future where open APIs will become linchpins of connected data systems.

As for government influence, Fridsma said meaningful use is, at this point, almost old news. Instead, he said to "look beyond the incentive programs – to payment reform, quality measures, and value-based purchasing."

Informatics – enabled by robust data sharing – "will be the key to getting paid in the future, particularly as we all start taking on risk," he said.

"Maybe there are ways we can leverage government resources to drive the market forward," he said. But "simpler interfaces and business drivers, ways to correct (past) market failures will be key to private sector success."

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