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Monday, June 4, 2018

Coloring within the Lines

When you first learned to color as a child, someone handed you a picture (like the following) and a bunch of crayons:
At first, you probably just threw blotches of color on the page, ignoring the lines. Then someone explained to you about keeping color within the lines. You practiced and practiced, and then realize that you could do really cool horse pictures within the lines. Then you turned your horse into a Zebra.
Not content with that, you made it into a Unicorn ... and later a Pegasus.

This is a metaphor for interoperability journey we started upon with Meaningful Use in 2010 and where we are headed in 2018.

First we had data that we needed to exchange, and a name for it (we called in the common clinical data set, but a horse by any other name is still a horse).  And we watched as everyone struggled to stay within the lines (the CCD specification).  Some even created a color-by-number guide that made it easier to make a pretty CCD.

When creating this horse picture, we stayed inside the lines with HL7 CDA, but to meet certain ONC requirements to make our horse look like a Zebra, we had to change the way we colored a little bit, but still came up with something that fit the lines (it just had a few more lines), and then we had our Zebra.

At times though, there were things that just didn't fit, and so we had to come up with a horn, or wings.  We did our best to create new lines that fit with (but not within) the existing lines, and went beyond the original drawing but still had the same general appearance, producing the C-CDA.

After a while, there's not much more to do with our horse (CDA), so we start with a new drawing (FHIR).  This horse will still get you from point A to point B, but much faster (no wings needed).

And that's progress in interoperability.


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