Interoperability: The High Jump and The Long Jump with ONC’s Doug Fridsma

I’ll admit, I was incredibly nervous about interviewing Dr. Doug Fridsma, the Chief Science Officer for the Office of the National Coordinator and the face of both the Standards and Interoperability (S&I) Framework and the Federal Health Architecture initiative. Not only do I consider him a key luminary, but his overarching responsibility for the future of interoperability and standards-based programs is incredibly alluring. I swoon over those who have the power and desire to effect meaningful, positive change on a grand scale. I wasn’t disappointed.

Doug explained his philosophy towards fulfilling the promise of interoperability with a sports metaphor: the high jump and the long jump.

“I don’t like high jumps,” he said. “High jumps, if you knock down the bar, you’re done and you get no points. Long jumps, you get points for each increment. The high jump for interoperability is ubiquitous data liquidity. The long jump is Meaningful Use.”

The S&I Framework project is tracking progress towards standardization and standards adoption across 5 areas of Meaningful Use and interoperability:

  1. Meaning – shared vocabularies across continuum of care
  2. Structure of messages shared across continuum of care
  3. Transport of messages
  4. Security of transport and messages
  5. Services for accessing messages

All of these categories are exemplified in the flagship project for Meaningful Use and interoperability: the Automate Blue Button Initiative, affectionately known as ABBI. For those not familiar with ABBI, do an experiment: ask your primary care provider whether you can visit a patient portal and download your medical records by clicking the “Blue Button.” If your PCP can provide you the website link to request the download, you should be able to receive your entire medical record (from that provider) in a vaguely huma-readable format (Excel, Word, PDF, etc.). The medical and clinical jargon may not make a lot of sense; however, it’s certainly an incremental hop in the long jump towards interoperability and standards adoption. The standard vocabularies, structure, transport mechanism, security protocol, and web-enabled access are foundational building blocks which enable the Blue Button program’s adoption.

Doug’s goal with the ABBI program was three-fold: get it OUT there, have providers and patients start USING it, and structure it so that it can be repeatable and scalable. Patient engagement advocates across the Twittersphere applaud the sentiment that we, patients, should have ownership of our health data, and many recognize the ONC’s efforts as instrumental in turning the tide for patient access. Several notable bloggers have covered the ABBI project in detail, analyzing its value to healthcare IT development professionals, providers, and patients, including:
Keith Boone @motorcycle_guy – the ABBI Pitch, with a quick overview of the goals for the program, and humorous insight into providers’ qualms about adoption

Greg Meyer @greg_meyer – Scalable Trust and Trust Bundles, with developer-focused details on the structure and transport categories of interoperability

For the next incremental long jump beyond ABBI and Meaningful Use Stage 2, Doug Fridsma and the ONC have several new initiatives tackling the atomic-level data governance and quality of clinical information. In order to communicate between disparate EHR systems, across multiple facilities and potentially multiple payers, it isn’t just the structure of the container and transport of the message that must be consistent: it’s the individual data elements, themselves, which comprise the meat of the message that must be standardized.

The ONC recently announced the Structured Data Capture Initiative with the goal of creating a technical infrastructure to support “structurally sound” standard data elements with support for “unique semantics”, to capture EHR and supplemental clinical data for use across the continuum of care. This effort officially kicked off the week of HIMSS 2013; its progress will be instrumental in broadening the effectiveness of interoperability and Meaningful Use.

So, as I walk the Interoperability Showcase at HIMSS13, watch the use case demonstrations, and ask the participants the tough questions like, “How are you incorporating the use case development you’re exhibiting here into consideration for your next product full release,” I’ll be taking note of those organizations that seem focused on the next incremental jump towards patient-centric, data-driven healthcare systems. And I’ll be wondering what Doug Fridsma and the ONC will do to get to the next incremental jump on the way to the nirvana of ubiquitous data liquidity.

…I’ll also be kicking myself for not taking the opportunity to get a fan photo with Doug while I had the chance.