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

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.

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