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Oy, Such a Headache You Give Me!

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“Standards and Interoperability” is a phrase that makes most of us pull the covers over our head and go back to sleep hoping it will all be gone when we wake up.  We use it to describe some important characteristics of information that we use every day in our work to provide services to our clients.  It is the basis of information exchange and the Universal Transfer Protocol.

It turns out that we live in a world of standards, shared agreements about measurement (miles or kilometers), electrical current (AC/DC 110 or 220), side of the road to drive on (right or left) and many others.  Your phone wouldn’t be so smart if it weren’t based on a pyramid of standards.  An I-phone talks to itself differently than an Android phone talks to itself.  However, they can talk to each other because they speak the same language to the cell phone tower and the tower speaks it back to them.  They share a communications “standard”.  Without that standard I-Phones would only speak with I-Phones, Androids with Androids, and no one would speak to Blackberries.  Not unlike Massachusetts, “… the Bay State, the land of beans and cod where Lowells speak only to Cabots and Cabots speak only to God.”

There are standards for information exchange as well; and these standards operate at different points in the process of sending and receiving a message:

  • Means of exchange: smoke signals, blinking lights, Morse Code, paper, fax, phone, email or direct electronic exchange.  Unless senders and receivers agree on an exchange standard it is not possible to exchange information.  Both senders and receivers must use the same method.  But method alone is not sufficient.
  • Language of the exchange: this is also called syntax and grammar, the relationship of a part of the message to the other parts.  It helps to speak the same language, whatever it might be, English, French or XML (a machine readable programming language).
  • Meaning of the information: what values can be given to a particular category of information and are those values understood in the same way by the sender and receiver?  For example, when a home health aide says someone is “independent” or “needs an assist” does that mean the same thing as a Physical Therapist using the same terms?  The process of reconciling potential differences in the meaning of specific elements is called “harmonization” with the goal of everyone using the same terms to describe the same state.

When there is a common agreement on the meaning of terms (a standard) then the information that is exchanged becomes “interoperable.”  That means it can be used in any setting by any user and have the same meaning.  When information is standardized and interoperable it has added value to the system because it can be reused in any setting and not just in the setting that created it.  Furthermore, it can be exchanged among settings using agreed upon language and process.  This is a prerequisite for electronic exchange.

Most of this work will be done at the national level by the new eLTSS Work group (electronic Long Term Services and Supports) sponsored by the Office of the National Coordinator for Health Information Technology (ONC).  All are invited to participate (  Your work on the UTP in Vermont will provide the basis for much of this activity.

Posted by Terrence O’Malley, M.D.


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