The national dialog about Interoperability is currently based on a shared conceptualization of interoperability as ‘moving data around’.
This is common across the standard definitions of interoperability from ONC, HIMSS, CMS and other authoritative sources.
The original Blue Button was – is – about moving your entire health record from their computer to your computer. Blue Button 2.0 standardizes the format, but it is still about getting your data. The initial use case supported by most Health Information Networks, and the network of networks interoperability frameworks such as Carequality and TEFCA, is about moving an entire EHR from one stakeholder to another.
This common conceptualization of interoperability as moving data around has its origins in our shared history of software solutions. Starting with slow mainframes in the 1960s, connected by even slower pipes, we have all learned that distributed computing is about moving files of data around. Our conceptualization of that was itself adapted from even earlier industrial production models – that is why we call them ‘batch’ files.
But as every software architect knows, and apparently few politicians and pundits, moving data around is by and large a last resort in IT. It is a concession to constraints in a particular solution arena that would otherwise prevent us from meeting non-functional requirements such as performance and availability.
The implementation design, the physical design, of a solution comes after the conceptual and logical designs. (It’s not quite that neat in practice, but naive billiard ball models are useful even if they don’t account for the nap of the cloth and the compressibility of the cushions.) The conceptual design is key. It is where we start, where we conceive the functionality of the tools and processes needed to enable our users to realize their objectives.
What is the conceptual design of healthcare interoperability? What is it we are all about that we may, indeed, end up moving data around to solve?
That is where the national dialog about interoperability should start. If we continue to start with the ‘moving data around’ implementation perspective, we will have to back out to the conceptual level again and again, in an ad hoc way, as we figure out what we are really doing. That path is not efficient. Those solutions will not be elegant.
Next up I will start down the path to cashing the check I just wrote : ) with a new definition of interoperability.
Stay tuned.
Health IT Architect 