Dr. John Halamka sees great potential for interoperable electronic health records, which could turn out to be “like Google for healthcare combined with Napster for healthcare,” says the CIO of the CareGroup Healthcare System in Boston. But first, standards need to be ironed out and technology hurdles need to be crossed. Halamka, who is chair of the Health Information Technology Standards Panel, sat down with Network World Senior Editor Deni Connor at the Health Information and Management Systems Society event in New Orleans this week and detailed the progress of standards for interoperable healthcare systems and the Bush administration-mandated National Health Information Network.

Tell me about your impressions of Microsoft CEO Steve Ballmer’s keynote address at HIMSS about XML being the panacea to interoperability between health information systems.

XML is a mechanism of transport but doesn’t necessarily describe content. What HITSP has done through this national standards activity that I lead is create interoperability specifications for medications, labs, allergies, demographics and population health to get to the granular level we are talking about. So are we using XML? Absolutely. But that’s a bit like saying ‘Do you speak English?’ It’s the difference between Shakespeare and a pulp novel. It’s all English.

XML is a higher-level protocol.

Exactly. XML, HTTPS, but then very specific constructs, so that when I describe a medication, I do it in an unambiguous way so that it’s clear that a hospital, doctor’s office, ER will all understand what that medication means, not just ‘Here’s a medical record in XML,' whatever that means. So here is what I did today [after Ballmer’s keynote], I forwarded my information through some HIMSS folks to Steve and said, ‘Look Steve, I look forward to working with Microsoft and aligning these national efforts of HITSP with the Microsoft healthcare framework [announced Monday] because it’s really specific. The example I gave today when I gave my standards talk regards gender. Normally you might think gender is only male, female and we can represent the standard vocabulary as M or F. That’s not true because there’s actually male, female, other, unknown, in transition, hermaphrodite characteristics, etc. So, if all you said in XML is female . . .