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AMIA Calls for Lab Data Interoperability Standards Improvements

At a workshop at the NIH, AMIA outlined its recommendations for lab data interoperability standards.

By Sara Heath

- To advance lab data interoperability, the American Medical Informatics Association says the industry needs agreement on health IT standards and advanced programming interfaces (APIs) such as FHIR.


In address at a multi-agency workshop at the National Institutes of Health, AMIA’s Gil Alterovitz, PhD, stated that various forms of technology are necessary to advance lab data interoperability and patient care.

“AMIA supports ‘Using a wide range of technologies, (e.g., web-based portals, telemedicine, apps and APIs, mobile health, and social media)’ and ‘Technology-enabled approaches that encourage patients to review and contribute directly to their record,’” said Alterovitz, who works with Harvard Medical School with the Computational Health Informatics Program at Boston Children's Hospital.

When inspected closer, these sentiments boil down to three key beliefs:

  1. A good standard separates structure from meaning
  2. Standards should be built on smaller building blocks to provide flexibility in use
  3. Standards must include context

“LOINC and SNOMED satisfy these points for some semantics of interoperability, but interoperability also needs API standards like SMART/FHIR for data conveyance,” Alterovitz explained. “SNOMED and LOINC have already transformed medicine and are critical for patient care today. Yet, there are places where they are better suited and others where they are not.”

As a result, AMIA recommends modular and substitutable health IT standards.

“A key example of the need for such modularity and boundaries is emerging in laboratory medicine where centralized code-based databases cannot keep up with rapidly expanding fields, like precision medicine,” Alterovitz explained. “For instance, it could prove especially hard for new codes to be coined and adopted quickly by the community.”

Additionally, Alterovitz recommended the use of pre-existing web technologies because they have already proven to work well with various infrastructure. This will ideally help advance LOINC and SNOMED.

With regard to patient safety and data security, AMIA recommends the technology industry design methods to keep patient data unidentifiable.

“Even associating a small part of the genome with an ID publicly can potentially identify the patient,” Alterovitz wrote. “Thus, since LOINC and SNOMED define individual concepts in publicly accessible ways, we may need complementary approaches for certain patient-specific information.”

Interoperable health data and technologies should also be usable, searchable, and easy-to-understand. By incorporating FAIR data principles (findable, accessible, interoperable, and reusable), technology developers should be able to improve technology use.

“Standards that enable modern APIs, including clinical app development, also provide a powerful way to search by LOINC and SNOMED, which transcends what we can do with older messaging technologies,” Alterovitz explained.

Ultimately, the healthcare technology industry will need to assess cost, complexity, and quality standards in order to address these recommendations.

“We have identified today exactly the type of use cases where a too simple metric will probably fail us in taking – or justifying – decisions,” Alterovitz concluded. “What AMIA says we should do is revisit what metrics we choose so that we can understand how MU3-based technologies can build our capacity to advance health care.”

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