By Mary Kratz
The healthcare industry is undergoing a major transformation, not only vertically within the industry itself, but also horizontally in its intersections with other disciplines. And this change is happening – every day – as the COVID-19 pandemic highlights the pervasive impact of public health on schools, social services, and many other aspects of society. As public health takes center stage, interoperability plays a critical role. The National Action Agenda to Advance Upstream Social Determinants and Health Equity (NAA), created by the Stewards of Change Institute as part of its National Interoperability Collaborative, brings together thought leaders to focus on advancing interoperability at scale. Most pointedly, an innovative proof-of-concept demonstration initiative called Project Unify – which is part of the NAA – is enabling both health sector and technology support in the face of COVID-19 challenges. Indeed, both Unify and the NAA are helping to create a holistic view of health across society, with increasing demands for interoperable solutions not just for healthcare services, but across human services and other historically separate domains.
Please join Stewards of Change for an informational webinar on Project Unify at 12:00 - 1:30 p.m. ET on Friday, November 6; click this link to sign up. For more information about the NAA, NIC and other Stewards initiatives, go to www.nic-us.org.
Much of the past decade has been largely shaped by making health data electronic. Electronic health record systems became pervasive with the advent of the HITECH Act. Originally, interoperability in this realm primarily involved transporting data from one “analog” repository to another. Today, given the exponential growth of electronic data and the increasing ubiquity of cloud computing, the focus has shifted to building “digital” infrastructure to effectively distribute electronic data where and when it is needed. The 21st Century Cures Act and subsequent CMS and ONC Final Rules reinforce the shift toward achieving nationwide digital interoperability – between systems and across sectors – as well as enabling individuals to easily access their own health data. Over the next five years, the focus will shift further, toward “use of data” to promote shared meaning from health information. Health data will be captured, analyzed, and combined to generate knowledge that can be put into use at the point it is needed to improve clinical care, drive process efficiencies between health and human services, document critical processes, reduce errors, and manage costs. Knowledge is changing at an accelerated pace; next-generation systems are now web-based, consumer-accessible, and Internet-enabled. The new horizon for Health IT no longer involves simply making data available from one organizational repository to another. Instead, it will center on a holistic, person-focused experience. This necessitates a new perspective on interoperability. Consumer-driven expectations include ‘’always available’’ services and “ever present” technology, reflecting current capabilities in financial services, social media, and news programming. Individuals now expect that their health history, as well as their access to care providers and social services, should be ubiquitously available, informed and customized by personal preferences and the seamless availability of their personal history. Several industry initiatives have emerged as foundational building blocks addressing the spectrum of interoperability. While market offerings within each of the “interoperability bands” are growing, there is burgeoning need for – but scant supply of – solutions that span the different types of interoperability. Several health vertical activities and trends that merit attention, investment, and collaborative partnerships to realize interoperability solutions include:
- Fast Health Interoperability Resources® (FHIR®) – HL7’s standard for modern, REST-based access to healthcare data has become a de facto data access approach with emerging ubiquitous marketplace support. 
- Da Vinci Project– An HL7-sponsored collaborative between healthcare payers and CMS to advance the transitions of healthcare systems toward value-based care models by addressing gaps between clinical and administrative data.
- CARIN Alliance—Focused on bridging between consumer-directed health and their caregivers by mobilizing electronic health information exchange, promoting access and sharing of electronic health information by consumers.
- Gravity Project—Creating national standards for representation of social determinants of health data within EHRs, to improve health outcomes and reduce costs. 
- BPM+ Health – A community of practice advancing the use and sharing of healthcare processes and pathways that can follow a patient’s journey of care and allow for knowledge expression and sharing among health systems and software products.
Innovative solutions designed to meet the demand for seamless and interoperable systems require a state-of-the-art, specifically tailored environment for testing. This need is why the Interoperability Institute has created Interoperability Land (IOL), a FHIR®-based healthcare sandbox that provides a space for advanced interoperability testing and development across different organizations and systems. (IOL is a primary sponsor of the Stewards’ National Action Agenda and an integral, excited participant in Project Unify). The shift from application- and institution-centric data repositories toward consumer- and internet-oriented delivery of knowledge has resulted in several trends that are impacting all verticals. These trends present opportunities for the health sector (a traditional technology market laggard) in the following areas:
- Data – Changes to data capture, storage, access, and use have moved from electronic data transit to aggregations of content in “data lakes,” resulting in always-available data.
- Ontologies – Formal vocabularies to represent data and metadata are enabling analytics and standardized reporting.
- Cloud Computing – Provides economy-of-scale infrastructure with integrated security, while minimizing capital investment in IT infrastructure.
- Componentization and APIs – Application Program Interfaces (APIs) provide interoperable software services. Componentization into microservices promotes reusability, speeds time-to-market, and reduces specific vendor and technology dependencies.
Interoperability sets the stage for the next phase of societal evolution, where the actions that are taken and the implications of past care marry with emerging practice and marketplace demands to inform and influence how decisions are made and, importantly, what courses of action need to be taken for continuous improvement. Mary Kratz is Executive Vice President of Interoperability Institute, a nonprofit LLC affiliated with the Michigan Health Information Network (MiHIN)  Health Level Seven (HL7) is the predominant not-for-profit health IT standards development organization.  Da Vinci Project. (http://www.hl7.org/about/davinci/index.cfm)  http://carinalliance.com  Health Level Seven International (HL7). 2020, Gravity Project. https://www.hl7.org/gravity/  <a href="http://bpm-plus.org