I have been getting increasingly uncomfortable with the assumption in interoperability standards work that we are working to acheive semantic interoperability. Information systems need to be useful, and shared information needs to be well enough understood to do the job - written notes are not very precise, or universally understood/interpreted in the same way -- they are created when there is something useful to do with them.
I suggest that as we look at interoperability standards, we should not always be looking for global consistency across all of healthcare around the world, but looking for where there is a role for lingua-francas that will share enough information to be useful, with enough consistency and clarity to be useful.
This means far more focus on what the intended use is - and moving away from assuming that because it is information, it must be expressed in a way that can be understood by every machine and every clinician.
Greater clarity as to what the purpose of sharing the data is, will help to clarify both the business case for making it happen, and the rules and agreements around the appropriate uses of the information that is shared.
By Charlie McCay