The Promise of The Promise of eHealth in the eHealth in the

Developing World:Developing World: The Challenges of The Challenges of Interoperability Interoperability

Charles Jaffe, MD, PhDCEO, Health Level 7

Health AffairsWashington

February 16, 2010

- Peter Drucker

“There is nothing so useless as doing efficiently that which should not be done at all.”

What is Interoperability?

• Sharing and (re)use data, across many

sites, without the loss of information• Exchanging information without

ambiguity of content, context or

meaning• Maintaining meaning for both the

human reader and the computer

- Unknown, with an apology to Rudyard Kipling

“If you can keep your head while all about are losing theirs and blaming it on you - perhaps you have underestimated the seriousness of the situation.”

Why is Interoperability so hard?

• Language is complex, but medical language is

even more so• Legacy technology is not easily discarded

• Policy supervenes technology• Privacy and security almost always contravene

simple interchange • Data without context degrades information

- Benjamin Disraeli

“How much easier it is to be critical than to be correct.”

What we need to make Interoperability easier?

• Identity of the owner. Whose data is it?• Meaning of the terminology. Who agreed to

say it that way?• Understanding of the transport

mechanism. How did you get it there?• Plans for sharing (and reusing). What can

you do with it?• Trust

- Samuel Johnson

"Nothing will ever be attempted, if all possible objections must first be overcome."

Standards drive Interoperability. Which ones do we need?

• Unique personal identifier• Enduring terminologies: ICD, LOINC, SNOMED,

and some others• Robust core data sets• Effective interchange standards: HL7, Clinical

Document Architecture, and maybe some others• Reliable quality measures• Appropriate privacy & security specs

- Charles Kettering

“If you’re doing something the same way for ten years, the chances are you are doing it wrong.”

Standards drive Interoperability. Which ones do we need…and

more?• Stable imaging standard: DICOM• Profiles, Master Patient Index, and Record

Locator Registries: IHE• Common terminology services: HL7• Decision support specifications• Clinical data warehouse specs: ISO• Meaningful Archetypes: openEHR, CEN, HL7• Architecture: ? Systems architecture

- Unknown, but no less verifiable

“If you can't be a good example, then you'll just have to serve as a horrible warning.”

Lessons learned from the Developed World

• There is no such thing as a free lunch…and “open source” doesn’t mean free either.

• The plural of anecdote is not data (Chris Chute). Corollary: development by consensus is hard…and slow.

• Measuring success is business critical.• The unintended consequences may have

more functional impact than the primary objectives.

- Milton Friedman

"If you put the federal government in charge of the Sahara Desert, in 5 years there'd be a shortage of sand."

Lessons that the Developing World taught us

• It’s easier to do it right the first time.• The most expensive solution may not be the

best one.• Winning has different meaning to different people.• The greatest need can be met by the greatest

good.• Stand-alone solutions almost always stand

alone.• Education trumps almost everything else..

-Unknown, but not Billy Crystal

“If you can't laugh at yourself, you may be missing the joke of the century.”

Thanks

cjaffe@hl7.org