[{"innerBlocks":[],"name":"core\/freeform","postId":3724,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"The lack of a universal terminology standard is a major barrier to communication between different electronic health record systems and the ability to derive clinical meaning from the shared EHR data.

While industry experts are working on ways to overcome this challenge, they disagree on the extent to which stakeholders should try to solve the problem of semantic interoperability.

Disparate EHR systems have their own inherent clinical terminologies. By leveraging common data models and vocabularies, these systems can \u201ctalk\u201d to each other in the same \u201clanguage,\u201d providing the ability to share clinical information and use it meaningfully.

Stan Huff, MD, chief medical informatics officer at Intermountain Healthcare, would like to see the healthcare industry make EHR data consistent through standardization of information models that are mapped to clinical terminology standards such as LOINC and SNOMED.

Also See<\/b>: AMA and IHTSDO set collaborative health terminology agreement<\/a>

Health Level Seven International\u2019s Fast Healthcare Interoperability Resources (FHIR) is gaining momentum as an open health data standard that has potential for meeting the need for semantic interoperability and minimizing the need for metadata translation services. FHIR is supported by a rich information model to achieve semantic interoperability of clinical data.

The Argonaut Project, an industry-wide effort to accelerate the development and adoption of FHIR, has created some profiles with detailed specifications for physical exam measurements such as heart rate, blood pressure and respiratory rate, Huff says.

Nonetheless, he contends that the Argonaut Project \u201chas not really specified the thousands of things you would need for lab data in a consistent way.\u201d As a result, Huff insists that, \u201cNow\u2019s the time to have the conversation about how we truly standardize those representations of data.

\u201cEven though (FHIR) is very good, there\u2019s a lot of work that remains to make it truly interoperable\u201d through the standard use of terminology and codes in transactions between systems, he adds. Even when FHIR is a normative standard, it will not be truly interoperable without additional information.

Also See<\/b>: 2017 emerges as pivotal year for FHIR interoperability standard<\/a>

\u201cJust saying that you\u2019re going to use LOINC codes or SNOMED codes doesn\u2019t mean that you\u2019ll end up with interoperable software,\u201d says Huff. \u201cFHIR services from one vendor are not identical to the same services from another vendor. Without some further understanding created, vendors will do it differently because the codes exist and they will just choose different codes. The good news for the vendors is that they don\u2019t have to do as much work to retrieve the data if they have choices in the codes.\u201d

For its part, Cerner is committed to implementing FHIR, which is already a part of its product offering, with the emerging standard serving as the basis for the company\u2019s open application programming interface, according to David McCallie, MD, Cerner\u2019s senior vice president of medical informatics.

\u201cThere are parts of FHIR that we\u2019ve already implemented and that our clients are using, and app developers are using and have deployed in production systems today,\u201d McCallie observes. \u201cBut it\u2019s not so simple as to say, \u2018Go use FHIR and we\u2019re done,\u2019 \u201d he adds. \u201cFHIR out of the box isn\u2019t ready to use\u2014you have to put profiles in place to constrain it to particular use cases, and which vocabularies and nomenclatures should be used.\u201d

He says that the higher the level of detail in the FHIR profiles for things such as conditions and vital signs, the greater the likelihood that the meaning will be exactly understood between sender and receiver systems. Nonetheless, McCallie notes that more detailed profiles are also more difficult to implement.

\u201cThere is a tradeoff you have to make depending on how deep you go into the profile of these FHIR resources. And Stan wants to go very deep, and some of us in the vendor community are concerned that that tradeoff might be too expensive for where we are today,\u201d he contends.

While there are many ways to describe certain lab tests in LOINC, McCallie contends that Huff\u2019s standpoint is \u201cthere should be one right way to do it, and the other ways should be deprecated.\u201d For now, EHR vendors are not willing to make a commitment to that level of standardization, he says.

\u201cWhy should they have to change just because some profile said there\u2019s a better way to do it?\u201d he asks. \u201cThat\u2019s the debate that we have around how deep to go into the semantic interoperability. On the vendor side, we want to be good enough to be useful and good enough to be implementable\u2014without a lot of delay and cost\u2014and then fix it and go deeper, as time allows in the future.

\u201cThere\u2019s a tradeoff point that\u2019s good enough and it\u2019s good enough for where we are in 2017,\u201d he concludes.

For his part, Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative and manager of the Argonaut Project, diplomatically notes that Huff and McCallie are both on the Argonaut Project team and offer valuable perspectives on FHIR.

Ultimately, however, he believes McCallie\u2019s point is correct that \u201cyou can\u2019t let the perfect be the enemy of the good as it relates to getting FHIR out into the field so people can start to use it\u2014I tend to be very practical in that sense.\u201d At the same time, Tripathi offers that \u201cyou don\u2019t want to stop doing the work that Stan\u2019s doing.\u201d

Still, Huff laments that some EHR vendors \u201cthink it\u2019s just too complex (and) too hard to do, and they compensate for that basically by putting more of the work on the people who are trying to use the data and who are trying to create applications that could be used across different vendor systems.\u201d

In the end, he predicts that \u201cwhat we\u2019re going to see is people implementing FHIR and getting real value from it and then recognizing that we need to do more work and even more standardization to get to the level of what I would call being truly semantically interoperable.\u201d","saveContent":"The lack of a universal terminology standard is a major barrier to communication between different electronic health record systems and the ability to derive clinical meaning from the shared EHR data.

While industry experts are working on ways to overcome this challenge, they disagree on the extent to which stakeholders should try to solve the problem of semantic interoperability.

Disparate EHR systems have their own inherent clinical terminologies. By leveraging common data models and vocabularies, these systems can \u201ctalk\u201d to each other in the same \u201clanguage,\u201d providing the ability to share clinical information and use it meaningfully.

Stan Huff, MD, chief medical informatics officer at Intermountain Healthcare, would like to see the healthcare industry make EHR data consistent through standardization of information models that are mapped to clinical terminology standards such as LOINC and SNOMED.

Also See<\/b>: AMA and IHTSDO set collaborative health terminology agreement<\/a>

Health Level Seven International\u2019s Fast Healthcare Interoperability Resources (FHIR) is gaining momentum as an open health data standard that has potential for meeting the need for semantic interoperability and minimizing the need for metadata translation services. FHIR is supported by a rich information model to achieve semantic interoperability of clinical data.

The Argonaut Project, an industry-wide effort to accelerate the development and adoption of FHIR, has created some profiles with detailed specifications for physical exam measurements such as heart rate, blood pressure and respiratory rate, Huff says.

Nonetheless, he contends that the Argonaut Project \u201chas not really specified the thousands of things you would need for lab data in a consistent way.\u201d As a result, Huff insists that, \u201cNow\u2019s the time to have the conversation about how we truly standardize those representations of data.

\u201cEven though (FHIR) is very good, there\u2019s a lot of work that remains to make it truly interoperable\u201d through the standard use of terminology and codes in transactions between systems, he adds. Even when FHIR is a normative standard, it will not be truly interoperable without additional information.

Also See<\/b>: 2017 emerges as pivotal year for FHIR interoperability standard<\/a>

\u201cJust saying that you\u2019re going to use LOINC codes or SNOMED codes doesn\u2019t mean that you\u2019ll end up with interoperable software,\u201d says Huff. \u201cFHIR services from one vendor are not identical to the same services from another vendor. Without some further understanding created, vendors will do it differently because the codes exist and they will just choose different codes. The good news for the vendors is that they don\u2019t have to do as much work to retrieve the data if they have choices in the codes.\u201d

For its part, Cerner is committed to implementing FHIR, which is already a part of its product offering, with the emerging standard serving as the basis for the company\u2019s open application programming interface, according to David McCallie, MD, Cerner\u2019s senior vice president of medical informatics.

\u201cThere are parts of FHIR that we\u2019ve already implemented and that our clients are using, and app developers are using and have deployed in production systems today,\u201d McCallie observes. \u201cBut it\u2019s not so simple as to say, \u2018Go use FHIR and we\u2019re done,\u2019 \u201d he adds. \u201cFHIR out of the box isn\u2019t ready to use\u2014you have to put profiles in place to constrain it to particular use cases, and which vocabularies and nomenclatures should be used.\u201d

He says that the higher the level of detail in the FHIR profiles for things such as conditions and vital signs, the greater the likelihood that the meaning will be exactly understood between sender and receiver systems. Nonetheless, McCallie notes that more detailed profiles are also more difficult to implement.

\u201cThere is a tradeoff you have to make depending on how deep you go into the profile of these FHIR resources. And Stan wants to go very deep, and some of us in the vendor community are concerned that that tradeoff might be too expensive for where we are today,\u201d he contends.

While there are many ways to describe certain lab tests in LOINC, McCallie contends that Huff\u2019s standpoint is \u201cthere should be one right way to do it, and the other ways should be deprecated.\u201d For now, EHR vendors are not willing to make a commitment to that level of standardization, he says.

\u201cWhy should they have to change just because some profile said there\u2019s a better way to do it?\u201d he asks. \u201cThat\u2019s the debate that we have around how deep to go into the semantic interoperability. On the vendor side, we want to be good enough to be useful and good enough to be implementable\u2014without a lot of delay and cost\u2014and then fix it and go deeper, as time allows in the future.

\u201cThere\u2019s a tradeoff point that\u2019s good enough and it\u2019s good enough for where we are in 2017,\u201d he concludes.

For his part, Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative and manager of the Argonaut Project, diplomatically notes that Huff and McCallie are both on the Argonaut Project team and offer valuable perspectives on FHIR.

Ultimately, however, he believes McCallie\u2019s point is correct that \u201cyou can\u2019t let the perfect be the enemy of the good as it relates to getting FHIR out into the field so people can start to use it\u2014I tend to be very practical in that sense.\u201d At the same time, Tripathi offers that \u201cyou don\u2019t want to stop doing the work that Stan\u2019s doing.\u201d

Still, Huff laments that some EHR vendors \u201cthink it\u2019s just too complex (and) too hard to do, and they compensate for that basically by putting more of the work on the people who are trying to use the data and who are trying to create applications that could be used across different vendor systems.\u201d

In the end, he predicts that \u201cwhat we\u2019re going to see is people implementing FHIR and getting real value from it and then recognizing that we need to do more work and even more standardization to get to the level of what I would call being truly semantically interoperable.\u201d","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

Emerging FHIR standard just the start of interoperability efforts

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