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Photo credit: ITI
Pictured, L-R: Dean Garfield (ITI) – Alec Chalmers (Amazon) – Mark Dudman (IBM) – Peter Lee (Microsoft) –– Greg Moore (Google)

Interoperability is an overlapping set of technical and policy challenges, from data access to common data models to information exchange to workflow integration – and these challenges often pose a barrier to healthcare innovation. Microsoft has been engaged for many years on developing best practices for interoperability across industries. Today, as health IT community leaders get together at the CMS Blue Button 2.0 Developer Conference here in Washington, DC, we’re pleased to announce that Microsoft has joined with Amazon, Google, IBM, Oracle, and Salesforce in support of healthcare interoperability with the following statement:

We are jointly committed to removing barriers for the adoption of technologies for healthcare interoperability, particularly those that are enabled through the cloud and AI. We share the common quest to unlock the potential in healthcare data, to deliver better outcomes at lower costs.

In engaging in this dialogue, we start from these foundational assumptions:

  • The frictionless exchange of healthcare data, with appropriate permissions and controls, will lead to better patient care, higher user satisfaction, and lower costs across the entire health ecosystem. 
  • Healthcare data interoperability, to be successful, must account for the needs of all global stakeholders, empowering patients, healthcare providers, payers, app developers, device and pharmaceuticals manufacturers, employers, researchers, citizen scientists, and many others who will develop, test, refine, and scale the deployment of new tools and services. 
  • Open standards, open specifications, and open source tools are essential to facilitate frictionless data exchange. This requires a variety of technical strategies and ongoing collaboration for the industry to converge and embrace emerging standards for healthcare data interoperability, such as HL7 FHIR and the Argonaut Project. 
  • We understand that achieving frictionless health data exchange is an ongoing process, and we commit to actively engaging among open source and open standards communities for the development of healthcare standards, and conformity assessment to foster agility to account for the accelerated pace of innovation. 

Together, we believe that a robust industry dialogue about healthcare interoperability needs will advance this cause, and hence are pleased to issue this joint statement.

While I’m new here at Microsoft, I’ve been focused over the past decade on lowering the barriers to innovation in healthcare, working closely with open source and standards development communities. I’m happy that my first blog post here at Microsoft aligns so well with my charter to collaborate on open cloud architecture with the healthcare community.

Electronic Health Records (EHRs) are approaching universal adoption in US hospitals and ambulatory practices, thanks in part to the Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Programs. The 21st Century Cures Act will make digital health data even more accessible with the call for open APIs.

In the context of US healthcare, many health record systems have focused on consistent representation for a key set of data elements defined by the Meaningful Use Common Clinical Data Set. As support for this common data set grows, it becomes easier to plug new tools into clinical workflows, analyze clinical histories, collect new data, and coordinate care. Many of these technical capabilities have been available within small, tight-knit health systems for a long time – but developing these capabilities has required complex, custom engineering and ongoing maintenance and support. Driving toward open architecture makes adoption faster, easier and cheaper.

As a medical student, I used to practice what I called “rogue interop” – connecting to services where I could, and cobbling together the data platform I wanted. It all worked, but it was a nightmare to maintain. Later when I joined the research faculty at Boston Children’s Hospital and started work on the SMART Health IT Platform, we wanted to build a robust platform to isolate app developers from the underlying details of an EHR system, so we started by designing new, open APIs from scratch and bridging to the underlying vendor system.

This work caught the attention of Health Level Seven (HL7), the healthcare standards development organization responsible for several generations of health data standards. When HL7 convened a “Fresh Look Task Force” to invite perspectives about newer, API-based approaches to data exchange, I was pleased to participate, sharing my experience from SMART.

This task force (among many influences) ultimately inspired the creation of Fast Healthcare Interoperability Resources (FHIR) – a more open, agile approach to the development of healthcare standards. I got involved with the FHIR community early when I wrote the first open-source FHIR server. Five years later, it’s been inspiring to see so many vendors, including Microsoft, supporting the emerging FHIR standard.

I joined Microsoft because it is among the largest contributors to open standards and open source. We actively contribute innovative technology to standards efforts in many industries, and we implement thousands of standards in our products that are formulated by a broad diversity of standards bodies. Just over the past year we’ve seen deep commitments to cross-cloud consumer data portability through the Data Transfer Project, an interoperable ecosystem for AI models through the Open Neural Network Exchange (ONNX), and the world’s leading software development platform through the acquisition of GitHub.

We at Microsoft are taking a collaborative approach to building open tools that will help the healthcare community, including cloud-hosted APIs and services for AI and machine learning. Microsoft understands that true interoperability in healthcare requires end-to end solutions, rather than independent pieces, which may not work together.

Most recently, we’ve added support for FHIR to the Dynamics Business Application Platform through the Dynamics 365 Healthcare Accelerator, and developed an open source Azure Security and Compliance Blueprint for Health Data and AI for deploying a FHIR-enabled, HIPAA/HITRUST in Azure. These solutions are results of Microsoft teams working closely with our partners to ensure all components of our product portfolio work together to serve the unique needs of healthcare scenarios.

Transforming healthcare means working together with organizations across the ecosystem. Today’s joint interoperability statement reflects the feedback from our healthcare customers and partners, and together we will lay a technical foundation to support value-based care. We expect that the assumptions from our joint statement will continue to evolve and be refined based on this open dialog with the industry.

Please join the conversation. You can find me on Twitter @JoshCMandel. If you want to participate, comment or learn more about FHIR, you can reach our FHIR Community chat at https://chat.fhir.org.