Doug Fridsma, MD, President & CEO, AMIA, Chapter 2

We all know that interoperability must be solved, but what’s the first step we need to take? Doug Fridsma believes it’s in changing the definition. “We need to stop thinking of it as a ‘utopian place’ where data can freely flow.” Rather, it should be viewed in a much simpler and more practical way — as “incremental added functionality.” In this interview, the CEO and president of AMIA talks about why interoperability wasn’t baked into Meaningful Use, why he thinks FHIR has great potential, and why patient access has become such a big priority for his organization.

Fridsma also reflects on his time with ONC, discussing some of the difficult decisions that had to be made and why he believes a “front-loaded incentive program” made sense when it came to Meaningful Use, and talks about the work AMIA is doing to advance the field of informatics.

Chapter 1

Chapter 2



* ONC’s interoperability framework

* Redefining interoperability — “It’s not a utopian place.”

* Working as a physician with Scottsdale Mayo Clinic

* Thoughts on FHIR — “There are a lot of good things about it”

* 80/20 rule

* “You can’t let perfect be the enemy of good.”

* Barriers to sharing



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Bold Statements

It’s about incremental added functionality. Going from a paper record to a PDF to something that is more structured — each one of those provides additional interoperability and the ability to both exchange information and use the information that’s been exchanged.

Interoperability is defined by the thing you want to do. That’s why the practical approach to measuring and defining interoperability is to say, what do you want to do, and given that, what’s the functionality you need to make it happen?

I’m pretty optimistic that FHIR is going to solve some of the problems we have with interoperability, and I think the people that are leading the effort and the governance structures that they’ve put in place have the potential to really make it useful.

You want something that you can constantly improve. I used to say the only standard you never change is the standard that you never use. If you use it, you’re going to find things that can make it better, and I think FHIR has that potential.

Gamble:  One of the words that keeps coming up is interoperability. I saw that a few months ago, AMIA gave a statement supporting the ONC draft framework to measure the use of interoperability standards and recommended a measured approach that focuses on the clinician-patient experience. Can you talk more about this from your organization’s perspective what you’d like to see?

Fridsma:  I think interoperability is one of those things that oftentimes is defined as a place — this notion that we’ll achieve this nirvana of data liquidity and interoperability when data can freely flow from one system to another. They define it as this utopian vision, but I think interoperability is not defined as this utopian place that we eventually will arrive at. Interoperability is really defined by the ability of systems to do things automatically that previously they couldn’t do.

If you want to measure interoperability, you have to define the thing you want to do. I like to give an analogy from when I was seeing patients. I would see patients the next day after they had been in the emergency room, and they’d pull out of their pocket this yellow carbon copy sheet from their visit. I was practicing at the Scottsdale Mayo Clinic — it gets hot there. If you take those yellow sheets and you put them on your dash in the 110 degree weather, they completely blanch,