The final session I attended at this week's Semantic Technology and Business Conference in San Francisco was on a topic with perhaps the biggest potential impact of any topic covered this week. The panel was called RDF as a Universal Healthcare Exchange Language, and it offered the attendees of SemTechBiz a glimpse into what occurred at an invitation-only workshop earlier in the week on the same topic.
The impressive group of panelists consisted of David Booth, Senior Software Architect of KnowMED (the company that won the Start-Up Competition earlier this week); Stanley Huff, Chief Medical Informatics Officer at Intermountain Healthcare; Emory Fry, Founder of Cognitive Medical Systems; Conor Dowling, CTO of Caregraf; and Josh Mandel, Research Faculty for the Children's Hospital Informatics Program at Harvard-MIT. The panelists prefaced their discussion quite elegantly in their description of the session:
"Healthcare information resides and continues to rapidly grow in a bewildering variety of vocabularies, formats and systems in thousands of organizations. This makes the exchange and integration of healthcare information exceedingly difficult. It inhibits access to complete and accurate patient data, undermines the key advantage of having patient data in electronic form, and drives up the already high cost of healthcare.
"The President’s Council of Advisors on Science and Technology (PCAST) identified the need for a universal healthcare exchange language as a key enabler in addressing this problem by improving healthcare data portability. Many familiar with Semantic Web technology have recognized that RDF/Linked Data would be an excellent candidate to meet this need, for both technical and strategic reasons. Although RDF is not yet well known in conventional healthcare IT, it has been beneficially used in a wide variety of applications over the past ten years--including medical and biotech applications--and would exceed all of the requirements outlined in the PCAST report."
So why RDF?
Serving as moderator of the discussion, David Booth presented a number of compelling arguments in favor of RDF. First, RDF takes syntactic and formatting issues off the table so that the people using the data can focus on core semantic issues. Second, RDF is schema promiscuous, meaning that you can create multiple models of the same data using RDF and those models can co-exist peacefully without wreaking havoc on the whole system. Third, RDF is a neutral and mature international standard governed by the W3C. It has the support and depth necessary to handle such a monumental task.
The panel was quick to note that RDF is not a perfect solution, and there will certainly be a great deal of difficulty in uniting the private healthcare industry under the banner of RDF--government mandates and incentives will almost certainly be a necessary part of this process--but more than any other tool, RDF has the potential to simplify and standardize healthcare data in a way that will make it exponentially more searchable, thereby making healthcare more affordable and more effective.
After going through a brief overview of how health data from disparate sources could be effectively connected via RDF, David shared a manifesto created at Monday's workshop, the Yosemite Manifesto on RDF as a Universal Healthcare Exchange Language, pictured below.
(The manifesto got the grand title of "Yosemite" because that was the name of the conference room that the workshop was supposed to take place in. When the meeting got moved to "Plaza A," the group decided Yosemite had a better ring to it.)
The panel presented each of the five points one by one, opening the discussion up to the floor:
1. RDF is the best available candidate for a universal healthcare exchange language.
The panel pointed out that there was some discussion on Monday about changing the word "language," because RDF is not, in precise terms, a language but more of a language medium or a language framework. More than one audience member liked the idea of dropping the word entirely and simply calling for RDF as the best candidate for universal healthcare data exchange. Ultimately, "language" will likely stay put in order to comply with the terms of PCAST.
2. Electronic healthcare information should be exchanged in a format that either: (a) is an RDF format directly; or (b) has a standard mapping to RDF.
This point sparked some entertaining debate about fixed URIs and situations within health data in which URIs don't exist at all. Josh ultimately commented that we all want what he calls idiomatic RDF--the kind of RDF that is clean and simple and easy to deal with--but that's rarely what we get in healthcare settings with data coming from so many disparate sources.
Someone else questioned whether the (b) section of the statement weakened the whole, but David was quick to respond that the addition actually shows the strength of RDF, because so many other languages can be easily mapped to RDF.
3. Existing standard healthcare vocabularies, data models and exchange languages should be leveraged by defining standard mappings to RDF, and any new standards should have RDF representations.
The panel commented that they are not interested in reinventing the wheel. Instead they're building a better axle that will help the wheel spin faster and more stably.
4. Government agencies should mandate or incentivize the use of RDF as a universal healthcare exchange language.
One audience member requested that this point be changed to simply, "Mandate RDF for everything." The audience and the panel liked this idea very much, but kept the language nonetheless. There was also discussion of changing "or incentivizing" to "and incentivizing" as well as calling for the use of RDF as "the" universal language, not simply "a" option.
5. Exchanged healthcare information should be self-describing, using Linked Data principles, so that each concept URI is de-referenceable to its free and open definition.
This point got a "Good luck!" followed by some good-hearted chuckles.
The goal of creating a universal healthcare exchange language, regardless of what it is, is to create semantic interoperability. Because the US health industry is privatized, there is no (easily explainable) incentive for pharmaceutical companies and hospitals to share their data, especially if not everyone in the field agrees to share. RDF cannot overcome this roadblock on its own, hence the need for luck.
Beyond luck, semantic leaders in the healthcare industry will need support from their colleagues, from amenable companies within the commercial and non-profit health worlds, and the support of non-tech types in the government who can push a set of ideas like this from manifesto to mandated policy.
Emory summarized this point quite elegantly at the end of the session: "For this to become a reality, we need to build examples of RDF in healthcare that are publically available." Only then will this plan become truly actionable. "We need a concerted effort and organization to give realistic and powerful examples of how RDF can improve care, save time, and save money. This is essential in order to drive the non-technical argument as to why standardization within the healthcare industry is so important."
Show your support for the manifesto and help push this important movement forward by signing the manifesto. Your support can help transform this proposal of uniformity, collaboration, and simplicity into actionable policy.
Images: Courtesy Angela Guess