How VA and DOD Can Approach Data Standards and Interoperability -- Before Standards Are Established

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As with most technology development, it takes time for standards to evolve, but agencies might consider turning to emerging technologies to help with interoperability and data-sharing challenges.

Lynda Joseph is capital area director at DSS Inc.

For organizations like the departments of Defense and Veterans Affairs, patient safety and quality of care are paramount, thus, having the ability to seamlessly share medical data with each other, as well as with other providers, is critical. Consider for a moment, a service person’s transition from active duty to veteran status. Patient records and critical medical history details must transition smoothly to ensure the patient receives appropriate, complete care at the right time.

As interoperability and information sharing efforts continue to pose challenges within the health care industry as a whole, standards must be developed so all entities can facilitate the transfer of data quickly, easily and efficiently. Even before such standards have been established, VA and DOD can strive for better interoperability and information sharing leveraging existing technologies used both in and outside of the health care industry.

Initiating a Long-term Strategy

As with most technology development, it takes time for standards to evolve. While this evolution occurs, however, agencies and providers alike might consider turning to emerging technologies to help with interoperability and data-sharing challenges.

For example, high-profile companies are successfully utilizing Fast Healthcare Interoperability Resources-based standards —a set of tools and solutions that use a well-known Web-based transport mechanism that provides a standard and secure way to transfer data from one system to another.

Because FHIR has shown promise and is starting to be used throughout health care, software developers are already becoming familiar with the technology, which is beneficial when creating new solutions for health care.

Also, FHIR contains structures that provide the ability to keep both original and translated code as information transitions, allowing organizations to trace it back to the original data to better understand the sender’s intent. DOD and VA can benefit from this greatly, as it enables organizations to maintain original data even if some is lost through multiple translations—a potential outcome during information exchange.

Thus far, FHIR prototyping has succeeded in showing promise in relation to data sharing initiatives within the industry. FHIR illustrates one way VA and DOD can leverage existing web-based technology to enhance interoperability today—even as standards are being developed.

Best Practices for Interoperability

Aside from FHIR, other existing and proven technologies are also available to help VA and DOD achieve full interoperability. For instance, these agencies could develop stronger interoperability strategies and solutions using open source tools in conjunction with a Service-Oriented Architecture.  

Currently, the Veterans Health Information Systems and Technology Architecture, or VistA, is perhaps the best-known example of a major electronic health record system built entirely on an open source platform. Using open standards, VA and DOD would be able to adopt a set of common, nonproprietary standards that allow for rapid software development. Having this agility would then help keep clinical information current, thereby enhancing patient safety and outcomes.

Conceptually, SOA is a secure service “data highway” where any type of health care information can travel and disparate systems can be connected. If VA and DOD were also to leverage SOA, it would enable these agencies to use legacy systems, applications and re-use assets such as existing software, reducing development costs and complexity through open standards and eliminating the need for costly point-to-point integrations. Moreover, as new clinical data would become available, the medical knowledge-base supported by SOA would stay up-to-date, ultimately supporting better outcomes of care and patient safety.

With SOA providing service processing and open standards for communications, agencies would be able to enhance patient safety by creating a service layer for requesting and receiving information such as medications checks, allergies and other specific clinical data.

For instance, queries in SOA could run against a database such as known drug interactions to ensure patients are not taking medications in combinations which may be harmful or ineffective. Additionally, agencies could also provide portals to their patients using this approach, allowing patients to access and update their own information, making patient–provider communication more efficient as well.  

Further government or industry developments, such as creating a central patient data repository, would also enhance interoperability and promote more seamless information sharing. Likewise, adopting cloud-based technology would support real-time data mining without duplicating patient information in existing databases. Using this technology, clinicians could access a cloud repository to see trends, enabling better population health management.

Using Today’s Technology While Looking Ahead

Although thoroughly tested and effective standards will take time to develop, organizations like VA and DOD recognize the importance and value of associating data from providers and patients to improve communications and information and enhance care quality for our service men and women. Achieving the final standardization framework and working with the Office of the National Coordinator may be a long-term process, however, DOD and VA IT leaders can use existing tools and techniques today to improve communication and ensure patient safety and overall outcomes.

By re-framing the discussion around the right tools, government IT leaders can help the industry take incremental or parallel steps toward better information sharing—making a meaningful difference now while future standards are developed.  

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