The Interop needle in 2030

ONC has been asking about Health Interoperability Outcomes for 2030.  Some sample statements they'd like the answers to include:

• “Because of interoperability, ______ before/by 2030.”
• “Because of interoperability, before/by 2030 [who] will [what].”

In Why We'll Never Have Interoperability, I note that the goal posts are always moving, bars are ever being raised, the needle just keeps going around and around.  So I thought it would be interested to look at this from the viewpoint of "what will we be concerned about" in 2030 as the next steps, rather than focusing on what we've accomplished.

Given all of that, these are the problems I think we will we still be trying to solve:

1. Making challenging content understandable to the average patient.
2. Making standards of care (e.g., care guidelines) measurable and computable.
3. Understanding the actual cost of care.
4. Crossing domain boundaries (care, payment, social services, public health, emergency medical services, research).  Each of these domains is still widely separated with respect to standards
5. Few of these domains have progressed as far with APIs as simple as FHIR.
6. Handling variations in dialects of FHIR as supported by different vendors.

And these are the problems that I think we will have made headway on:

1. FHIR will have become ubiquitous in hospital and ambulatory practice interfaces between healthcare systems and devices.  It will become available in not just EHR systems, but also departmental, laboratory, medical devices, revenue cycle, and to some degree, imaging systems (although DICOM will retain significant dominance).
2. Patient facing APIs will be ubiquitous.
3. Visit scheduling, and much of the pre-visit "paper-work" will be done via the web for most patients.
4. FHIR will have crossed into the payer space, and HIPAA transaction standards, invading some of the territory previously owned by X12 and NCPDP.
5. We will start to see FHIR transition into other healthcare related domains (e.g., EMS reporting, social services), but adoption will be limited.