Re: [sbis_l] Artigo muito interessante sobre interoperabilidade em TI em saúde nos EUA

"Healthcare IT has been burdened by too many standards, offered
University of Pennsylvania sociologist Ross Koppel, a former chair of
AMIA's evaluation working group, and a frequent critic of large,
established EHR vendors. For example, he said, there are 40 different
ways to record blood pressure in EHRs, and perhaps three of them are
"proper" from an informatics standpoint"

É por isso tão importante que o Brasil tenha tomado a decisão de
adotar um modelo de referencia nacional para representação de
informação clinica,publicando a portaria 2073, diferentemente dos EUA
que prefere um modelo de mensagens que não padronizam o conteúdo
clinico, pelo menos não de uma forma estuturada, apostaram em usar
terminologias para expressar esse conhecimento. Mas isso está mudando
com a iniciativa CIMI, que começou como um fresh look do HL& e que
agora é independente, e que tem entre seus membros o estruturada
Departamento de Defesa Americano (DoD), o National Institutes of
Health e o NIST, que é uma espécie de INMETRO deles. E lá, como cá, o
modelo openEHR foi escolhido como formalismo para representar os
modelos clínicos detalhados.

abs
Jussara Rötzsch
Md, MSc
Director, OpenEHR Foundation
Owner, Giant Global Graph ehealth Solutions




On Thu, Nov 8, 2012 at 4:23 PM, Renato M.E. Sabbatini, PhD
<listas@edumed.org.br> wrote:
> AMIA: Why interoperability is 'taking so darn long'
>
> By Neil Versel, Contributing Writer
> Created 11/08/2012
>
> CHICAGO – Hospitals can have hundreds of IT systems. Vendors have built
> proprietary databases. Not everyone follows the same standards. Health
> systems fear sharing data with competitors. Policymakers have not focused on
> health information exchange or EHR usability.
>
> These are just a few of the reasons why true interoperability of health
> information remains so elusive, according to a panel of informatics
> luminaries.
>
> "Technology is only one obstacle to interoperability," said Gilad Kuperman,
> MD, director of interoperability informatics at New York-Presbyterian
> Hospital, who moderated the panel at the just-concluded American Medical
> Informatics Association (AMIA) Annual Symposium about why interoperability
> is "taking so darn long.
> "
> Charles Jaffe, MD, CEO of standards development organization Health Level
> Seven International (HL7) described a "circle of blame" involving government
> agencies and regulators, hospitals and healthcare systems, technology
> vendors, clinicians, academicians like those at AMIA and, yes, standards
> development organizations (SDOs), such as HL7. "The policy always preempts
> the technology," said Jaffe.
>
> "And just like [in the 1983 Cold War movie] WarGames, in this
> finger-pointing, no one wins." He noted that not-for-profit HL7 in September
> made most of its standards and other intellectual property available free as
> a means of building trust for HL7 communications messaging. "Without trust,
> none of this is possible," Jaffe said.
>
> Harry Solomon, interoperability architect at GE Healthcare, and a lecturer
> at Oregon Health and Science University, explained the road to
> interoperability with four numbers: 2, 4, 3 and 5.
>
> There are two overarching concepts that need to be defined, namely
> interoperability and standards, and Solomon said "good enough" definitions
> exist from Institute of Electrical and Electronics Engineers (IEEE) and the
> International Organization for Standardization, known as ISO. Therefore,
> healthcare should not have to do any more in this arena. "We can't afford to
> have custom integrations for every data transfer that we have," Solomon
> advised.
>
> The number 4 stands for the levels of interoperability specification:
> workflow, messaging, format, vocabulary.
>
> The other two numbers represent three phases – standards development
> (generally handled by an SDO), product development (vendors), and system
> deployment (users) – and five process steps for each phase.
> These steps include: the decision to proceed on each phase; allocation of
> resources; development; validation; and deployment.
>
> Healthcare IT has been burdened by too many standards, offered University of
> Pennsylvania sociologist Ross Koppel, a former chair of AMIA's evaluation
> working group, and a frequent critic of large, established EHR vendors. For
> example, he said, there are 40 different ways to record blood pressure in
> EHRs, and perhaps three of them are "proper" from an informatics standpoint.
>
> Koppel argued that meaningful use stems from a plan hatched by vendors 30
> years ago to sell more software with the help of government subsidies and
> did not always have interoperability in mind. Koppel said that a 2009 New
> England Journal of Medicine article by then-national health IT coordinator
> David Blumenthal, MD, Ashish Jha, MD, and other Harvard researchers that
> heavily informed Stage 1 meaningful use regulations did not ask a single
> question about usability, patient safety, interoperability, data standards
> or what Koppel called "clunky interfaces."
>
> One attendee, David McCallie Jr., MD, the vice president of medical
> informatics at Cerner, challenged Koppel's assertion, saying that vendors
> got together with ONC and created the open-source Direct Project that anyone
> can use right now to exchange health information securely. The complexity
> comes from incorporating it into EHR code and into workflows.
>
> McCallie further noted the speed in which the industry developed the
> continuity of care document. "It happened in two years, which in standards
> terms is lightning fast," he said.
>
> Koppel was more praiseworthy of the new Stage 2 rules. "I really appreciate
> what has been done in MU2. It's a marked step forward," he said. He also
> acknowledged that health IT has so many components, complexities and "moving
> parts," making interoperability particularly difficult.
>
> Solomon said that interoperability often falls off the priority list when
> vendors update products, and urged AMIA members to demand it.
>
> "Interoperability is not an unachievable goal," Solomon said. He cited the
> DICOM standard in radiology that is essentially universal today.
>
> Source URL:
> http://www.healthcareitnews.com/news/amia-why-interoperability-taking-so-darn-long
>
> Links:
>
> [1] https://twitter.com/share
> [2]
> http://www.healthcareitnews.com/directory/health-information-exchange-hie
> [3] http://www.healthcareitnews.com/directory/electronic-health-record-ehr
> [4] http://www.healthcareitnews.com/directory/interoperability
> [5]
> http://www.healthcareitnews.com/directory/american-medical-informatics-association-amia
> [6]
> http://www.healthcareitnews.com/directory/health-level-7-international-hl7
> [7]
> http://www.healthcareitnews.com/news/amia-regenstrief-pumps-its-clinical-decision-support
> [8] http://www.healthcareitnews.com/directory/ge-healthcare
> [9]
> http://www.healthcareitnews.com/news/chicago-proclaims-informatics-week-it-hosts-amia
> [10] http://www.healthcareitnews.com/directory/meaningful-use
> [11] http://www.healthcareitnews.com/directory/blumenthal-david
> [12] http://www.healthcareitnews.com/directory/cerner
> [13] http://www.healthcareitnews.com/directory/direct-project
>
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