Health Data Infrastructure Required for Interoperability
By - Without well-developed and -managed health data infrastructure data to move efficiently and securely between healthcare organizations, providers, and patients and realize the far-reaching benefits of health IT interoperability. This was the central takeaway from a 2014 report by an independent group of scientists known as JASON.
"Whether any of these benefits can be realized depends not only on the framework for health information technology and exchange, but also on the details of any such implementation. "It is therefore vitally important to get those details right," states the report commissioned by the Agency for Healthcare Research and Quality (AHRQ).
So how then does the healthcare industry go about developing a robust health data infrastructure? According to the JASON report, the answer to that question is the developing of "unifying HIT software architecture" driven by several core patient-centered principles.
Be agnostic as to the type, scale, platform, and storage location of the data: The principle requires that an HIT software architecture be able to both work with a wide range of technologies and adhere to specific system-wide principles for health data exchange. In particular, this agnosticism takes aim at the type, scale, platform, and storage location of data.
Use public APIs and open standards, interfaces, and protocols: Readily available application programming interfaces (APIs) provide a common starting point for health IT develops to focus on innovations around EHR interoperability. Open standards, interfaces, and protocols define a common language for developers and technologies to communicate seamlessly
Encrypt data at rest and in transit: Health data privacy and security can easily become impediments to true interoperability if not sufficiently addressed. "The software architecture should minimize inadvertent exposure of health data by keeping all health data encrypted, both at rest on storage systems and in transit across networks. While encryption will not solve all security problems, it helps to minimize data breaches and is not costly to implement," the research group asserts.
Separate key management from data management: Based on the need for scalability as part of a HIT software architecture, it becomes unnecessary cumbersome to apply an audit-based model to manage the means for accessing encrypted data and the overall management of data that never go delves into the specific contents of data.
Include with the data the corresponding metadata, context, and provenance information: What data comprises and how it came to be are two entirely distinct things, JASON observes. Primary and secondary data elements help create a complete picture of a piece of information. As the report notes, standardization of medical imaging provides a cautionary tale about not capturing metadata and provenance information.
Represent the data as atomic data with associated metadata: This principle comes down specificity with regard to data elements so that each can be handled individually and as part of a larger whole, which becomes increasingly important as secondary and tertiary use cases emerge that require the use of one or a combination of specific data elements.
Follow the robustness principle: be liberal in what you accept and conservative in what you send: The robustness principle comes down to flexibility so that imperfections in specifications do not cause systems to become closed off to each other. "For example, if a vendor adds additional fields to the metadata of a laboratory test result, that should not cause the data to be rejected," the authors posit.
Provide a migration pathway from legacy EHR systems: The inability to support the transition from today's to tomorrow's EHR technology will introduce dangerous information gaps. A wealth of health data currently resides in legacy EHR systems and requires extraction. According to the JASON report, public APIs have an important role to play in freeing this data and allowing new EHR systems " o take shape even before all of the data reside within the architecture."
The JASON report is but one proposed pathway to achieving widespread interoperability. However, the support its garnering from both the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) should lead to many of its principles become part of regulatory demands on providers, developers, and patients.
