Dr. Doug Fridsma | January 3, 2013

This week marks the beginning of a new year, and I’m looking forward to the challenges ahead. One of my resolutions is a renewed commitment to a broader conversation about all things standards, technology, research and innovation.

Over the coming weeks, I’ll update readers on what we are doing in ONC’s Office of Science and Technology. This will include conversations about:

What it means to develop an interoperable health care system;

What the community is doing to advance the technical framework of meaningful use;

The work being done to create not only a learning health care system, but a “health care system of learners;” and

Exciting innovation work that is pushing the boundaries of how health care providers and patients interact.

My goal is to increase the communication (and conversations) that we can have with the larger health IT community.

The community of providers, vendors, standards geeks (of which I am one), and innovators has accomplished a lot this past year in terms of health IT standards, and should be proud. There are more accomplishments than I can list here, but here’s a sample:

1. Standardizing Meaning

We established four primary vocabulary standards for medications (RxNorm), problem lists (SNOMED), administrative transactions (ICD-10), and laboratory test results (LOINC). While these vocabularies have been around for some time, this is a first step toward creating consistent and reproducible use of these vocabularies.

For more information: National Library of Medicine Value Set Authority Center.

2. Standardizing Structure

We have, for the first time, agreed upon a national standard to support transitions of care and patient care summaries (C-CDA). The communities that developed the consolidated CDA have done a remarkable job in creating re-usable templates and building blocks that should accelerate the use of standardized structure. We will have to continue to push for simplicity and parsimony in our health IT standards, and the CCDA is a remarkable step along that path.

For more information: Standards and Interoperability (S&I) Framework – Transitions of Care Initiative .

3. Standardizing Reporting

We have a consistent national standard for public health reporting of laboratory tests, based on HL7 2.5.1 standards. While many other flavors of public health reporting standards are still used, we have a clear and consistent target that every electronic health record (EHR) will be able to use.

For more information: S&I Framework – Public Health Reporting Initiative .

4. Standardizing Transport

We have a universal way to consistently and securely send information from one EHR system to another using the DIRECT protocol, and optionally, to the streamlined web services standards developed in the NwHIN pilots.

For more information: S&I Framework – Implementation .

5. Standardizing Access

The Blue Button activities have made it possible for millions of veterans and people with Medicare to gain access to their health information. Now the community is working on standardizing the health care information that the Blue Button provides (based on the CCDA) and expanding Blue Button to include other kinds of data like financial and billing data from CMS.

For more information: Automate Blue Button Initiative .

Framework Supports Standardization Initiatives

Through the S&I framework, we have supported the community in initiatives that have worked on digital signatures (esMD), piloted ways to ask questions to EHRs and get consistent answers back (Query Health), created standards to share important information from hospitals and doctors’ offices with long term care facilities (LTC), explored ways of protecting parts of an electronic health record that require extra protections (DS4P), and are creating standard ways to share and access clinical decision support information. Information about these initiatives and more can be found at S&I Framework website .

2013 will be an exciting year. We are looking ahead to the challenges of creating the foundations of a learning health care system in which every provider and patient has access to information that can help them take better care of their patients and themselves. We need to continue to work on promoting information exchange among health care providers, and working to refine our efforts on interoperability.

Next week: Is there a difference between information exchange and interoperability?

For More Information