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Plays Well with Others, continued from page 3 Sensmeier said those business agreements are an equally important part of the overall interoperability equation. The success among health systems has led to such agreements moving into other healthcare sectors including the prison systems, EMS, and VA, Sensmeier noted of the local uptake in her region. She added San Diego isn’t unique and that such collaboration is occurring in pockets across the country. “There’s now an understanding it’s the right thing to do and good business,” she pointed out.

National Breakthroughs

Movement is also happening on a national level. Last month, after nearly two decades of work and advocacy by the HIT community, Congress included report language in the FY17 Omnibus spending bill to address a prohibition on the unique patient identifier (UPI). The ban, which was put into place in 1998, stemmed from concern over patient privacy. The result, however, has stymied efforts to accurately match patients to their data across different systems and settings of care on a national basis. In a blog post, Carla Smith, MA, FHIMSS, CNM, who serves as executive vice president for HIMSS, noted that over the last 19 years, the UPI language has prohibited the U.S. Department of Health and Human Services from engaging in any conversations with the private sector pertaining to the UPI. Over the past two

decades, she said, it has become clear that a consistent patient data matching strategy is required across the public and private sectors of healthcare. While the new Omnibus language does not allow HHS to use funds “to promulgate or adopt any final standard providing for the unique health identifier for an individual” without Congressional authorization, it does open the door for HHS to be able to study the issue through the following clarification: “Accordingly, the Committee encourages the Secretary, acting through the Office of the National Coordinator for Health Information Technology (ONC) and CMS, to provide technical assistance to private-sector led initiatives to develop a coordinated national strategy that will promote patient safety by accurately identifying patients to their health information.” ONC officials have also announced the launch this month of a Patient Matching Algorithm Challenge. The challenge, which includes up to $75,000 in prize money, has a goal of spurring the adoption of performance metrics, reducing duplicative entry, and improving the linkage of critical data. More information is available at PatientMatchingChallenge.com. Additionally, Sensmeier said, the ONC has been working to improve data exchange and usefulness through the Interoperability Standards Advisory (ISA). “ONC has raised the bar on identifying what standards are available in interoperability and what those

HIMSS Defines Interoperability

standards serve,” she explained. Through the website healthit.gov/isa, there is a single public list of the standards and implementation specifications, which are published and open for comment. “It’s a huge step forward,” she said.

In April 2013, the HIMSS Board of Directors approved a definition of HIT interoperability and outlined three functional levels: foundational, structural and semantic. At the highest level, semantic, two or more systems have the ability to not only exchange information but also to be able to interpret and use that data. As outlined in the definition, “Semantic interoperability takes advantage of both the structuring of the data exchange and the codification of the data including vocabulary so that the receiving information technology systems can interpret the data. This level of interoperability supports the electronic exchange of health-related financial data, patient-created wellness data, and patient summary information among caregivers and other authorized parties. This level of interoperability is possible via potentially disparate electronic health record systems, business-related information systems, medical devices, mobile technologies, and other systems to improve wellness, as well as the quality, safety, costeffectiveness, and access to healthcare delivery.” The board noted the creation of data exchange schema and standards should permit data to be shared across organizational settings and with patients regardless of the application or application vendor. Work to create and broadly implement such standards is ongoing.

Next Steps

“The nut to crack is that providers and hospitals need to be requiring interoperability in the systems they purchase,” Sensmeier stressed, adding interoperability should become a foundational part of the procurement process. “If the customers are asking for it, the vendors are more likely to make sure it’s there,” she noted. “I think the will is there,” Sensmeier continued of movement across public and private sectors to address interoperability. “We have the standards now, and we’re pointing people to them.” While the U.S. is still probably several years out from deploying a comprehensive national strategy, Sensmeier said it is encouraging to see more pieces and parts come online. She noted interoperability certification programs are now in place; there is increasing patient demand and expectation that health information travels with the individual; and new provider reimbursement methods require improved connectivity across the continuum of care. In meeting these demands, HIT products and systems should be well on the way to fulfilling the promise of enabling providers to deliver safer, more cost effective care.

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