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Comment by twobyfour | Hacker News Reader

Were global (or at least nationwide) technical standards and specifications for data exchange protocols never defined as part of this mandate?

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No they were not. The quote, by David Blumenthal who designed the HITECH legistlation said this:

"Before you can create interoperability, you have to create operability"[1]

I'll leave it to you to decide whether this was a wise philosophy to underpin a major national IT project.

[1]http://www.healthcareitnews.com/news/blumenthal-look-stage-1...

It seems to be the exact opposite philosophy that HIPAA originally took in the effort to get financial/administrative transactions to electronic formats, which was essentially that mandating interoperability would drive mainstream use.

Not really, but there are some standards, like HL7[1]. But HL7 has some shortcomings. Lately there is an effort afoot to create a new standard called FHIR[2]. The problem is, even if the standard is finished and is GREAT, there's no way of knowing if the various vendors will actually implement it.

[1]: https://en.wikipedia.org/wiki/Health_Level_7

[2]: https://en.wikipedia.org/wiki/Fast_Healthcare_Interoperabili...

FHIR is probably the best we are going to do for a long while to come.

If you're ever interested in learning more, my company builds the national reference implementation of SMART on FHIR for the Harvard DBMI, in support of the NIH 'Sync For Science' Pilot - happy to talk all about FHIR and data exchange standards!

The participating vendors will be launching pilots this year and things are proceeding well. If we can give them some positive attention for it, maybe we'll see some progress. I sure hope so!

[]https://www.healthit.gov/buzz-blog/health-innovation/nih-and...

Where do you see things headed in terms of FHIR adoption? Personally I think SMART/FHIR is fantastic; getting vendors to actually use it is the real challenge...

I wasn't aware of this NIH 'Sync for Science' program though, very neat!

I've been a part of a few standards/interop efforts. Postel's Law and my experiences indicate those efforts are non-starters.

I also participated NHIN's first competitive interop whatever it was called. (We were sub to Northup Grumman. Our team won. Yay. That recognition plus $3 will get you bad cup of coffee.)

The secret to interop is to ignore the standards. No one else cares, so why should you?

For inbound, just capture whatever is sent, use web scrape style tools to extract the bits you care about. For outbound, manually create payloads that work (maybe with SOAP-UI and then tweak), turn them into templates.

If you're a monster org like Boeing or Toyota, you can rule by fiat. Everyone else has to fake it.

Nationwide yes - The program is commonly referred to as Meaningful Use. There were a number of requirements related to data exchange, and it moved the needle slightly.

All the requirements are written as a numerator/denominator format. For example, 25% of all lab orders placed by a provider need to be resulted electronically. So there's an incentive to integrate some things, but not all.

Edit: here are the 2015 rules and accompanying underlying standards: https://www.healthit.gov/policy-researchers-implementers/201...

Without bickering over MU requirements, you'd probably note that MU has been almost entirely ineffective at solving actual care problems with data exchange.

Of 50 state exchanges, most have collapsed, with only occasional use of the ad-hoc implementations and networks that remain. And people dying everyday while vendors like ECW get wrist-slaps for lying to CMS about their MU compliance.

-http://www.healthcareitnews.com/news/eclinicalworks-pay-155-...

Agreed - there is still a huge hurdle of connecting all the fiefdoms of healthcare - my colleague calls it the connectivity problem: https://www.redoxengine.com/blog/the-connectivity-problem

When someone asks us to integrate with a small EHR, the first thing we look at is ONC certification. We at least know that they meet some base level of functionality.

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