Comments on: A great visual for healthcare IT interoperability

By: Phlebotomist

Phlebotomist — Thu, 20 Aug 2009 07:30:15 +0000

I would have to agree Shahid, Some folks on here want Uniformity, which is great but it is just not how the world or our health system works. For all intents and purposes the machine on the top allows for many more uses and more connection options. More options is always better simply because the chance of you have the equipment needed to utilize the machine is more likely to be on hand. Also the hospital has a choice of which they would like to use, such as less expensive adapters or more expensive Higher quality adapters. I think the model with simply 3 jacks is sub standard. Not to mention if the utilizer wants to see his display on 2 separate monitors, or simply a computer monitor I imagine he is going to need the top device.

By: Schlomo Gould

Schlomo Gould — Mon, 27 Jul 2009 16:56:18 +0000

This is an interesting thread, but I believe it is skipping past a major consideration. Not a surprise, as this interop debate continues to do the same thing…and that’s data standardization.

Everyone wants to get ‘the phones connected together’ but if one of us is speaking French, and the other Chinese, we have a problem.

Enter semantic standards…LOINC, SNOMED-CT, ICD, etc.

Focusing on the digital connections in most world’s is fine since everything is base-10. Or in the digital world, binary. But medicine is practiced in ‘base 26′ due to the text-based, narrative collection of data. If I chart ‘BPWR’ and send that over an HL7, or any other standardized interface to another system, the receiving system can capture that, and present it to the recipient. But does the recipient know what it means? [Blood Pressure Within Range]

Absent that clarity, do they take a blood pressure, wasting time and cost?

And the biggest challenge is that most EMRs (albeit not all) don’t normalize the data in any way. This is touched-upon in the reference to templates. But if the EMRs were designed properly, the UI would allow flexibility, but the Db would normalize the data. Once thats done, the world is our oyster for interoperability. This is being done in other coutnries, including the UK (started with Read Codes, now onto SNOMED-CT, et al), Netherlands, etc.

Absent this, we are going to have an explosion of data moving around, none of which means anything to anyone.

Focus on mobilizing the data in a meaningful way, not the bits and bites.

By: Bart

Bart — Tue, 24 Feb 2009 17:28:10 +0000

Great comments! Thank you for taking the time to write down your opinions.
I see HIT as a sum of different applications and devices. These applications differ locally and organizationally. Depending on the situation applications A + K + X might suit you best, whereas G + K + W + X might be better for your neighbor. Point is that both combinations will result in the best possible healthcare in their particular setting.
In all honesty: how many applications do you know talking fluently to different other apps and devices? How many applications prevent choosing the best possible combination because of the absence of interoperability?

By: Chintan Patel

Chintan Patel — Mon, 23 Feb 2009 20:06:07 +0000

Neat. Google Android versus iPhone App Platform?

By: yampeku

yampeku — Mon, 23 Feb 2009 16:23:06 +0000

There is another standard a lot better than CCR, the ISO standard to EHR communication
http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=40784

By: Shahid N. Shah

Shahid N. Shah — Mon, 23 Feb 2009 02:19:25 +0000

I think perhaps folks aren’t really understanding the analogy of the picture (which is my fault for not explaining). Let me talk through what the first one shows:

Pointers to A, B, and C refer to RCA standard jacks and S-Video. These are technologies that were invented in the 60’s, 70’s. 80’s which mean if you have a TV from that era it would still work with this device. Think about how many healthcare apps we have from decades ago — we need to get/set data in those systems. These could be CSV files or other structured text files.

D points to DVI standard input — which comes from a computer, not TV. Imagine that in healthcare the DVI is HL7 3.0. DVI is the most recent video standard (just less than 10 years old).

E, F, G point to VGA standards — which come from the 80’s and 90’s. This is like HL7 v2.x.

J points to USB standard — this is a completely different standard than video and audio, it’s about data transfer.

So, all the slots in the top picture are pure standards — just that the standards are for different purposes (but no better/worse).

Our healthcare systems need to support all the standards since there can never be “one standard to rule them all.”

Example: HL7 is a transactional standard for clinical data, X.12 is a transactional standard for financial and management data, CCR/CCD is temporal snapshot of an entire patient record. CDISC is used in transfer of clinical trials information, etc. The list goes on.

Modern systems need to understand the various standards and why they are used and the implement them in their systems for open communications.

Hope this helps explain why the top one is far more useful analogy in healthcare than the bottom one.

I love this thread

By: ANut

ANut — Sun, 22 Feb 2009 22:11:07 +0000

The first figure represents a world without standards: complex and expensive. Many standards = no standard.
The second figure is a world with few standards: systems simple and inexpensive.
My question: The first model is sustainable? Which component is applicable? For the individual components (EHR, etc.) or integration Middleware? Thanks and congratulations for the interesting blog.

By: ANut

ANut — Sun, 22 Feb 2009 22:01:51 +0000

My question: The first model is sustainable? Which component is applicable? For the individual components (EHR, etc.) or integration Middleware? Thanks and congratulations for the interesting blog.

By: first aid supplies

first aid supplies — Fri, 20 Feb 2009 21:09:47 +0000

Hey guys i think this is really great involvement of IT in Health care…….

By: Shahid N. Shah

Shahid N. Shah — Fri, 20 Feb 2009 13:03:35 +0000

Charlie, excellent comment. Thanks for sharing. I don’t think it’s much of a controversy, just a style of architecture — are we looking for more inputs/outputs vs fewer. Until the business side of the clinical world has decided on the “best” or “one single way” or “a few simple ways” of connecting their universes the technology and architectures that we create need to be inherently flexible and conducive to change. I would love to have single, simple standards that everyone adheres to but until our users’ incentives get aligned on the business side that won’t happen.