Cerner SVP of medical informatics: 7 requirements to foster interoperability

It's easy to get caught up in the perceived failures of interoperability, but the industry should take a moment to reflect on all the progress made so far. These were the sentiments offered by David McCallie, MD, senior vice president of medical informatics at Cerner, in a guest post on the "Life of a Healthcare CIO" blog of John Halamka, MD, CIO of Boston-based Beth Israel Deaconess Medical Center.

In his post, Dr. McCallie reflects on overall industry feelings toward interoperability.

"It's fashionable to complain that we haven't 'solved interoperability,'" Dr. McCallie wrote. "This is certainly true, but we have come a long way and have achieved significant and lasting advances."

These achievements include deploying a standard for electronic prescribing, establishing a standard for secure email and widely implementing a standard for document-centric query exchange, according to Dr. McCallie. Additionally, the healthcare industry is nearing support for a standard that would encode complex clinical data into summary documents and has made great strides toward interoperability via application programming interface, he wrote.

Despite these achievements, the industry is hung up on what has not yet been accomplished, particularly from the government, Dr. McCallie wrote.

"The refrain we hear from Capitol Hill is that we have failed to achieve the seamless interoperability that many had expected. This has led to numerous legislative attempts to 'fix' the problem by re-thinking government approaches to the standard setting processes authorized by [the] HITECH [Act]," Mr. McCallie wrote. "I think the biggest mistake Congress appears to be legislating is to assume that standards alone are what creates interoperability."

While standards are necessary, they are not the sole determining factor of the possibility of interoperability, according to Mr. McCallie. He offered the following seven conditions critical for interoperability.

1. A standard needs a business process. Standards can't exist on their own; rather, they augment a process or working practice.

2. Standards need to be developed through frequent testing and validation.

3. Healthcare organizations, even just a group of them, need to implement and use the standard, again in a business purpose, such as satisfying regulatory requirements or meeting market pressures.

4. The industry also needs" network architecture" that provides the framework for identity, trust and security concerns related to sharing data.

5. In order for the industry to share healthcare data, Dr. McCallie said a "business architecture" must be in place that oversees contractual and legal concerns regarding the exchange of data.

6. Additionally, there needs to be some sort of governing body that can ensure network and business frameworks are followed by participants.

7. Infrastructure indirectly related to the standards is imperative to the standard being successful, according to Dr. McCallie. "Almost no healthcare standard can be deployed in isolation, so all of the ancillary infrastructure must be organized and deployed in support of the standard," he wrote.

It will take the work of the entire industry to achieve interoperability, not just mandates from the government.

"We've learned that forcing providers to simply deploy standards and then to expect interoperability to happen is ineffective policy," Dr. McCallie wrote. "Congress should accordingly define the 'what' and let the US healthcare stakeholders define and achieve the 'how.'"

More articles on interoperability:

Cerner CEO Neal Patterson testifies before Senate on HIEs: 4 key thoughts 
The missing link in interoperability: What patients want 
Plug-and-play in action at the Center for Medical Interoperability 

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