Interoperability: Enabling the future of health care

Cerner’s Dr. David McCallie explains Cerner’s view on interoperability and open platforms, and explores how interoperability impacts patient care in this interview on health IT. This content previously appeared in a HIMSS Show Daily publication at HIMSS 2015.

Q. Interoperability is in the spotlight as government agencies, health care providers and EHR partners consider how to support the exchange of data easily among disparate systems. What is Cerner’s philosophy on interoperability?

A: Interoperability is essential to a provider’s ability to improve the quality of care. We strongly believe that every patient has a right to have their health information available to their providers, at the point of care, regardless of the system or vendor of origin. While the entire health care industry will benefit from interoperability, ultimately, patients stand the most to gain. As a patient, you shouldn’t have the burden of filling out the same medical history over and over again, and you shouldn’t have to carry physical copies of your health records from doctor’s office to doctor’s office. The industry as a whole needs to work together to solve this problem.

Q. Right now there is a lack of common standards in the health care industry when it comes to interoperability. How is Cerner advancing widespread interoperability?

A: Cerner has long been a pioneer of interoperability. Common standards across the industry are a must. In some cases, good standards exist, but in other cases, new standards and new approaches are needed.

Back in 2009, I worked with industry partners to create Direct, a simple secure emailing standard designed to create universal “push” connectivity to providers at other organizations. I am proud of the fact that Cerner has contributed more than 180,000 lines of open source code to Direct, code that is now used by many Direct implementations. Based on its ability to allow providers to communicate with one another, it was incorporated as a Meaningful Use requirement.

In 2013, Cerner co-founded the CommonWell Health Alliance, a vendor-led collaborative committed to achieving ubiquitous, nationwide “query” interoperability. In November, Cerner offered to provide free CommonWell Health Alliance services to our clients until January 2018. Several other CommonWell members have done the same since then to encourage rapid growth of the network.

Cerner continues to demonstrate its commitment to interoperability by contributing both financial and intellectual capital to new standards, like HL7’s Fast Healthcare Interoperability Resources (FHIR), that allow for easy access to the discrete data elements that make up the patient’s clinical record. Last year at HIMSS, we demonstrated the ability to use FHIR to enable “SMART App” plugins to our EHR platform. We have expanded on that capability this year at HIMSS, and anticipate general availability to our clients later in the year.

In December 2014, Cerner announced our participation in Project Argonaut, a vendor and health care organization collaborative that committed to contribute resources to advance the  adoption of FHIR.

Cerner continually works with our competitors with the goal to have an effective national health data exchange.

Q. What is an open platform, and how does it relate to interoperability?

A: Open platforms are structured in ways that make it easy for other systems, including those of competitors, to access the data stored within them. These types of systems facilitate interoperability by making it easier to move information in and out of their systems and to repurpose it in ways that advance patient care.

The most exciting open platform work underway at the present time is the SMART on FHIR specification, which enables third-party applications to be plugged directly into the EHR workflow. These “apps” allow for new functionality to be exposed to patients and to clinicians, while maintaining the security and integrity of the core medical record. We also expect to see a new generation of consumer-facing mobile apps that can leverage FHIR and other standards to directly access data within the EHR. We believe that these emerging apps will become another key aspect of interoperability, by providing the patient with a direct connection to their own medical data.


About Dr. McCallie

David McCallie, M.D., is senior vice president for Medical Informatics at Cerner, a global leader in health information technologies. Dr. McCallie is responsible for a research and development team focused on developing innovations at the intersection of computer science and clinical medicine.

In addition to his efforts at Cerner, he is working with other industry collaborators to create a standards-based approach for enabling EHRs to become open platforms for application development.  Prior to this, he was integral to the creation of the CommonWell Health Alliance, a multi-vendor trade association that delivers widespread EHR-to-EHR interoperability. Dr. McCallie also helped create Direct, a simplified approach to secure clinical messaging, which is now a key component of Meaningful Use.

Dr. McCallie has published numerous articles and presented frequently on the subject of healthcare informatics. He is a member of the American Medical Informatics Association.