Dr. Lynn, CIO of M.D. Anderson, Houston, Texas had an interesting guest article on HisTalk blog on interoperability and healthcare and how it is an oxymoron given that the Health Information Exchanges are using existing intra-organization architecture as a basis for enabling inter-organization sharing of data.
In summary Lynn highlighted the need for two different architectures for intra-organizational clinical workflows and inter-organization interoperability. And provided a great Internet analogy to get a sense what this architecture would look like. The inter-organization interoperability architecture should not duplicate data collection and should facilitate quick searches of relevant data variety of sources and link data to a unified patient index.
Here is my take on the subject:
To see interoperability architecture in principle and practice you don’t have to look far. IHE’s XDS architecture framework enables inter-organizational interoperability. At a high level there are three components, XDS Registry, Repository and Consumer. XDS registry is a search index of clinical data and XDS repository is a wrapper around existing clinical repository to update the search index(XDS registry). There is an XDS Consumer- essentially a portal that enables a clinical user to view unified EHR on a patient. Essentially its a federated architecture that leverages existing clinical data sources and investment and enables interoperability for a HIE.
And IHE XDS is based on SOA framework( to answer RadioGuy) and uses web services for communication between the relevant systems. For some reason, IHE doesn’t seem to strike a chord with HIT folks in US where as, its not the same in rest of the world. Is this the reason for HIEs focus or reliant on EMR’s intra-organizational architecture ?
If you want to see IHE XDS based inter-organization interoperability systems live and running, you just have to come to Canada (currently implemented in Diagnostic Imaging). Its being currently implemented in province of Alberta, Quebec and Ontario all using IHE XDS as a framework and funded by Canada Health Infoway ( a Canadian Federal Organization) that funds Canadian equivalent of US HIE’s.