At a minimum, there are three types of interoperability required to achieve an interoperable health IT ecosystem, according to Doug Fridsma, M.D., ONC’s outgoing chief science officer.

Speaking this week at AHIMA’s 2014 conference in San Diego, Fridsma made the case that health IT requires all three types of interoperability--semantic, syntactic, and information exchange. “If you exchange the information and the codes don’t match or it’s a proprietary set of codes, you’ve got the information but you have no idea what those codes mean,” he argued. “Semantic interoperability is about the vocabularies and syntactic interoperability is about the structure.”

The end result, Fridsma said, is to have the ability of systems to exchange information and to use the information that has been exchanged, while taking advantage of both the structuring of the data exchange and the codification of the data including vocabulary—with the receiving systems able to interpret the data.

According to Fridsma’s definition, interoperability is the “ability to exchange information and the second part is to use the information that’s been exchanged,” and “being able to use it is all about semantic interoperability and understanding the information that’s there.”

“This is sort of a little geeky but I’m going to put it out there. I think we need to move from declarative semantics to what I call computable semantics,” he added, in which descriptive logic in terminologies is leveraged to create “computable representations” of concepts.

Fridsma challenged the current practice of leveraging lists of codes and instead advocated for a query-like way of describing the concepts for a quality measure. “CMS right now is managing quality measures and what they do is have somebody sit down and go through all their vocabularies and they create this list of codes that defines what a diabetic patient looks like if you were to query it and pull that out of a medical record,” he said. “The problem is that as this begins to proliferate we aren’t going to be able to manage it. What we need is the equivalent of a computable way.”

To address this challenge, Fridsma suggested that computable semantics could include semantic web, the OWL Web Ontology Language, and other emerging technologies.

Describing himself as the “geek at ONC,” it was recently announced that Fridsma is leaving his post in November to become president and CEO of the American Medical Informatics Association. At ONC, he has been responsible for the scientific and technical strategy for the ONC portfolio of technical resources to support the meaningful use program and health IT interoperability.

In June, ONC released its vision for where it wants to see the country by 2024 with respect to health IT interoperability, based on five critical building blocks: core technical standards and functions; certification; privacy and security; business, clinical, cultural and regulatory environments; and governance and rules of engagement. Currently, ONC is developing a 10-year roadmap for achieving a nationwide interoperable health IT infrastructure, with the plan expected in January 2015.

“Interoperability—because of its definition—is about exchange and use. And, so, the only way we get to interoperability is using the information,” Fridsma concluded.

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