The Future of
Standards
John D. Halamka MD
HITSC Workplan Activities
S&I Current Activities
Potential New S&I Initiatives
Current S&I Ballots in Process
Feedback from the
Trenches
• Content
• Vocabulary
• Transport
Content
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The RIM is important for creating content standards
but should be invisible to implementers
A 16 year old without healthcare domain knowledge
should be able to create an arbitrary structured
content document with novel data fields
In the near term, CCDA and FHIR must co-exist. In
the future FHIR may supplant CCDA
JSON is easier to generate and parse than XML
HL7 3.0 is not going to be widely used for messaging
in the US
Vocabulary
• The Value Set Authority Center has
collected almost all needed vocabulary
and code sets
• There are a few gaps - uniform
adoption of LOINC for
allergy/severity/reaction, UCUM for
units of measure, EHR support for
structured data capture
Transport
• RESTful approaches that use OAuth2
and OpenID are easier to implement
than SMTP/SMIME or XDR with PKI.
• Trust fabric solutions are still evolving
and trust anchor exchange is what is
working now
• Push, Pull and View are all valid
interoperability architectures
“Healthcare is not special”
• We need to abandon the idea that
healthcare needs unique approaches to
exchanging payloads of data.
• HTML and HTTP = FHIR and
REST/OAuth2/OpenID
• Simple and functional is more important
than addressing every edge case
The Path to the Future
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Certification needs to be redesigned to focus on
interoperability using real clinical scenarios
Optionality needs to be eliminated (OR means
AND and destroys in interoperabilty)
Modularity needs to be enabled
Implementation Guides should not be based on
“indirection” but should stand alone
How do we create an “app” ecosystem in a
world of EHR consolidation/attrition?
The Next 3 Years
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For now, continue version 2.x for messaging
transactions in the US - ADT, orders, results until it can
be replaced by FHIR
For now, continue CCDA for transitions of care until it
can be replaced by FHIR
Aspire to a future of FHIR over REST using JSON with
OAuth2/Open ID authentication
Reduce optionality - OR means AND
Focus on the building blocks and not narrow fixed use
cases i.e. require APIs in all EHRs as part of Meaningful
Use Stage 3
Questions?
• http://geekdoctor.blogspot.com