Interoperability: E Pluribus Unum

Abstract

Healthcare information technology is on a quest for interoperability, driven by the Report of the Commission on Systemic Interoperability: “Ending the Document Game”, published in 2005. In that document, interoperability was described as “connectivity—constant, instant access to your medical information…” (http://endingthedocumentgame.gov/PDFs/entireReport.pdf) and was viewed as critical to nothing less than transforming health care in the United States. The report exhibits the frustration and, at times, anger over the sorry state of medical information in the US, particularly as it relates to reliance on paper, poor quality of documentation content, the duplication of effort to obtain useful information, lack of availability across platforms and distances and especially the role that this lack of connectedness plays in causing actual harm to patients and huge costs to our economy. The Commission’s recommendations reflect the imperative and urgent need for total reconstitution of how we obtain, share and use information in the work of healthcare, especially in patient care, but also in the many other activities which enhance health of individuals, communities and populations. The Commission projected a 10 year timetable to achieve the goals they laid out. We are not there yet, and in fact we still have a long way to go.

This chapter will describe the many terminologies, nomenclatures and classification systems used in healthcare, which ultimately and ideally will be winnowed down, combined, modified, edited and standardized into a single, uniform, encompassing communication tool which permits the exchange of all types of information – clinical, financial, regulatory, demographic, quality- and safety-related, public health and epidemiologic – between and among various digital platforms, institutions, systems, applications, vendors, devices and individuals, and makes that information usable without special effort by all who are authorized and need it. In short, e pluribus unum.