Question from Greg Meyer, distinguished engineer at Cerner:
Optionality vs Extensibility: What effect is the large selection of standards and technology in the health IT domain having on interoperability? Do we need to eliminate optionality and focus more on extensibility?
In my view, optionality is the death sentence of interoperability. That statement deserves a bit a context starting with the definition of optionality. Simply stated, optionality is the ability to choose one or more entities with complete disregard to supporting alternate entities. Applying that to interoperability, it means you can choose a single option (or multiple) from an enumerated set of options to perform a task without the requirement of supporting the rest of the options in that set. The result is a multitude of systems supporting different option sets where there may be no intersection of compatible options. The end game: no universal interoperability.
Possible solution: extensibility. Start with a required set that EVERYONE MUST SUPPORT. No optionality allowed in the required set. Now that sounds like a limiting factor; extensibility to the rescue. It’s entirely possibly to build new innovative standards and solutions on top of or in parallel of existing options in a backward-compatible way, but without a required common set of standards, interoperability is destined to failure.
Unfortunately we are seeing too much of the optionality methodology in health IT across multitudes of standards such as transport, data modeling, and content. A prime example is the Meaningful Use stage 2 transitions of care requirement where content and transport optionality is killing the ability for providers to universally communicate.
Optionality is a mere single characteristic in the complex domain of Health IT, but a shift in philosophy will be necessary to reach the nirvana of universal interoperability.
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