Wednesday, 26 August 2015

AHA Report on Interoperability: Implications for Canada

The American Hospital Association released an insightful report on health data interoperability this week.  You can download it here.

Practically all of the hospital systems we run in Canada are American, so we would be wise to watch interoperability developments south of the border.

Here are a couple of sections of the report that seemed relevant to the Canadian interoperability landscape:

1. Pilot Test Standards before making them official:

To date, the federal government’s selection of standards for inclusion in the certification of EHRs has yielded mixed results. Future activities must be more grounded in whether standards are ready for use and accompanied by sufficient implementation guidance. The federal government should support the maturation of standards through pilots or demonstrations to determine the viability of the standard before inclusion in a federal regulation that mandates use. For example, ONC could support voluntary certification of draft standards that are being matured in pilots or demonstrations projects, which would signal federal support for innovation without imposing an immature standard on the entire provider community. With evidence from real-world pilots that a draft standard can be scaled for ubiquitous use and has moved to become a mature standard, the federal government can then consider whether regulations are needed to advance use of the standard.
Wow, just imagine if Canada had done this for HL7v3 *before* we sunk $1B into that standard...

2. States and provinces need to get out of the business of standards development:
State governments should be discouraged from establishing unique requirements that increase variation in standards and policies because variability diminishes the ability to share information across state lines. State policies also may play a role in establishing the business case for information sharing and infrastructure development..
The main benefit to developing national standards isn't ability to move data across state/province boundaries.  It is the huge savings in software procurement and system integration.

3. CCDA challenges.
The current iteration of content standards, such as the Consolidated Clinical Document Architecture (CCDA), do not meet the needs of clinicians for relevant clinical data. The CCDAs shared for meaningful use include large amounts of patient data, making it hard for clinicians to easily identify the information that is important
Having worked with CCDA from multiple systems in the U.S. this comment surprised me.  The problems I saw with CCDA was not that it had too much data, but rather that  there are huge gaps in the CCDA produced by the current generation of hospital systems and little consistency between the CCDA produced by the different systems.


  1. Hi Ken. Great summary! Regarding point #2, I agree with you that the huge savings in software procurement and system integration is one of the main benefits of having national standards. I would argue though that having an interoperable data at the national level is as important, as it enables integration and analysis of data at the national level for health system use purposes (e.g. clinical program and health system management, research, and public and population health use).

    1. Excellent point Finnie. We've been so caught up in just getting something up and running that there is rarely any thought given to the secondary use objectives.

    2. I recently wrote a very short editorial on InfoCentral re: the importance of including HSU/secondary use needs as systems are planned/developed. You might want to check it out.