Charles Jaffe, M.D., chief executive officer of nonprofit health IT standards organization Health Level Seven (HL7) International, discusses ICD-10 and how it will interact with his group's health data exchange standard, Fast Health Interoperability Resources (FHIR). Jaffe also shares his thoughts on interoperability and the absence of a national patient identifier in the U.S.
This is part two of a Q&A SearchHealthIT did with Jaffe. Read part one where Jaffe explains how FHIR can become a health IT standard.
Let's talk a little bit about ICD-10. How will ICD-10's introduction, whether it's this year or next year or whenever, interact with standards such as FHIR? Are there any issues there?
Charles Jaffe, M.D.chief executive officer, HL7 International
Charles Jaffe: For more than a year now, HL7 has had a tight relationship with the terminology standards. In fact, we have a working entity within HL7 called the Terminology Authority, and the purpose of that group is to ensure the seamless integration of terminologies into HL7 to make the coordination of transport and terminology as seamless for the end user as possible.
What special challenges does the U.S. health IT environment -- as opposed to, let's say, Europe -- hold for interoperability and data exchange, and how can HL7 FHIR and other standards help promote interoperability here in the U.S.?
Jaffe: HL7 is international and we make standards for the world; we don't make standards just for the United States. Having said that, many of the realm-specific developing projects like Consolidated Clinical Document Architecture [CDA] have been sufficiently adopted around the world for varying use. We suspect that solutions which have been tailored to the United States will continue to be leveraged globally. I think more importantly, we recognize the fact that key HL7 development projects rely heavily on the contributions of the international community. I have every reason to suspect that will be the case long into the future. So interoperability for the U.S. simply reflects interoperability in the rest of the world.
In Europe, national patient identifiers are widely used, making interoperability easier. How will interoperability with health IT standards advance here in the U.S. without a national patient identifier?
Jaffe: To my knowledge, the rest of the developed world has a unique patient identifier. By law, the United States does not have such an identifier. That turnaround, to which I subscribe, is not likely in the near future. There are strong advocates for the idea that patient identification without the unique identifier is satisfactory, and I don't have personal data on whether that's true or not. I think there are sufficient examples of successful patient identification and individual identification nightmares. You only have to look at your credit report, which after all is based on your Social Security number, to know that there are problems with that.
What kind of new standards can we expect to see coming in the next few years?
Jaffe: The key standards development that a truly global community is anxiously awaiting is a mature, normative standard of FHIR. We have partnered with a host of other organizations to leverage HL7 FHIR. We believe this will help nourish a rich greenfield environment. At no time do we think that legacy systems -- which are working, which are mature and very satisfactory -- will be replaced by FHIR. But there are so many new opportunities.
In addition to that, we're working with organizations that support other areas of standards development. We have a nascent global health work group which is investigating critical opportunities in enabling mobility. Mobility is much more than having an EHR on a mobile device. Mobility is connecting the thousands of users and devices that are immediately tethered to a computer or an information system. We think that this is critical whether in the hospital or in an ambulatory setting.
Lastly, there are some partnerships that are developing standards for the learning health system. We are all committed to an idea that extracting information from an electronic medical record is not the beginning and end of enhanced healthcare at a lower cost. It's about having data from the research community, informed patient care, as well as closing the loop and having patient care inform on the next big step in research. There are those of us who are in constant collaboration with the clinical research industry in order to enhance this learning health system process.
ONC, as part of its 10-year roadmap, has released its new interoperability standards advisory. What's your perspective?
Jaffe: The standards which have been identified in there certainly include CDA, Consolidated CDA, as well as FHIR. And we think that the critical element in this is that its standards advisory is iterative. I have spoken to [national health IT coordinator Karen DeSalvo, M.D.] ... and she assured me that this [is the case]. This is in place so it could be revised and enhanced when necessary, probably yearly. The community of the EHR vendors and people who have to implement it, whether in the private or nonprofit sector, are eager to have this as a working model. So I applaud it.
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