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Healthcare Integration – 4 Core Principles to Do it Right – Part II

Healthcare Integration with Metadata

Descriptive Metadata, an Easier Road to Healthcare Integration?

A theme of the PilotFish recent blogs is that we have to get real, fast, and change our ideas about how to achieve healthcare integration.  In “A Robust Health Data Infrastructure”, a report from JASON, The MITRE Corporation proposes a very comprehensive possible software architecture for the exchange of health information.

Some of the core principles of the proposed architecture from JASON were:

  • Be agnostic as to the type, scale, platform, and storage location of the data
  • Use public APIs and open standards, interfaces, and protocols
  • Include with the data the corresponding metadata, context, and provenance information
  • Represent the data as atomic data with associated metadata

PilotFish has looked at this proposed architecture with great interest as it very closely aligns with our own architecture and design. In Part I of this blog on the JASON report, we discussed how being agnostic takes us closer to interoperability. To go on, when it comes to Open API’s the world is our oyster. Requiring the ability to leverage Open API’s enables rapid connectivity, provides easy access into systems, and reduces costs, all good things.

Open standards remove entry barriers to less financially able entities unable to afford high-priced standards organization memberships.  Open protocols, in the same manner, facilitate data sharing easily and seamlessly.

Moving healthcare integration forward has to be affordable in order to become ubiquitous. By leveraging Open APIs, open standards, and protocols, we can eliminate outrageous usage fees, access fees, and licenses that currently have a stranglehold on the industry. Do we really want to exclude any entity on the basis of fees rather than validity of their ideas in this newly connected healthcare world?

Let’s look at the next JASON recommendation on metadata and why metadata inclusion is so important.

Metadata is often defined as data about data. It is “structured information that describes, explains, locates, or otherwise makes it easier to retrieve, use or manage an information resource”, especially in a distributed network environment, for example, the internet or an organization.

In principle, the healthcare industry agrees on the value of greater metadata use. Entities across the board have recognized that metadata tagging has the potential to increase the usefulness and integrity of data for information exchange by better describing the information being shared.

By including descriptive metadata, the data becomes easier to work with by all members of the healthcare ecosystem, and specifically by less technical individuals. Inclusion should also lower costs.

The JASON authors also underscore the utility of representing the data as atomic data with associated metadata.

A software architecture that can represent the individual elements in an EHR (e.g., blood pressure measurement, serum glucose level), together with the associated metadata, will provide maximum flexibility in data handling and security. The atomic data elements can be reassembled in various ways for either clinical or research purposes, and distinct user permissions can be associated with each data element. (Page 28)

With Necessary Change Comes Winners and Losers

The report is sure to shake things up. As is always the case, there will be winners and losers. The EHRs and EMRs that have closed systems, proprietary formats, and don’t utilize Open APIs have the most to lose. Legislation is now being called for to decertify these kinds of systems.

In our blog of 8/7/14, we explained that we tell our clients who are outside vendors that our software can connect to anything, if the EHR vendor provides the access. And that’s the big if. Many of the EHRs usually won’t provide easy, if any access. So, it’s not an interoperability issue that’s the roadblock, it’s the access issue.

Healthcare is not a luxury. It is as essential as food and water in a civilized society. We all share a responsibility to make it work well and a cost that is sustainable.

The report goes on to outline a means to a very achievable goal for a Robust Health Data Infrastructure. The caveat, in my opinion, is if we can all just get real.

Check out PilotFish’s online HL7 Vocabulary Tool, it’s a free web-based reference for the HL7 Standard. It displays various types of other metadata including complete documentation of the imported standard, including all Elements and Attributes, Types, Attribute Groups, Message Types, Enumerations, and Codelists. These tools make implementation of the HL7 standard easier.

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Monika Vainius

Written by: Monika Vainius

Executive Vice President of Applied PilotFish Healthcare Integration. Monika has extensive experience with systems interoperability. She combines this experience with her professional passion for healthcare and healthcare technology to comment on current healthcare and IT news. Website

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