I was in the air longer than I was in Europe this week (Chicago Monday, Brussels Tuesday, Seattle Wednesday), but the time I spent there was extremely educational. There is a real question as to what constitutes interoperability - or in other words, what is the definition of interop. I think this is a good conversation to have, but it is not ultimately going to result in any strong conclusions as to what we, as an industry, need to do about it. Nor, what the role of government is in this process.

In Europe, there is much more awareness about the different layers of interoperability, and the fact that technology is only one of those layers. If you talk to some policy folks, they will point to semantic and organizational interop as the next 2 layers above technology to describe the issue. But some of my colleagues in MS have pointed out a very important, and even more difficult 4th layer which is legal.

Here is a scenario that may help think this through. Imagine a Lithuanian citizen wants to have medical care in Germany. The doctors in Germany want the patient's medical and insurance records. Tech: the computers that hold this info have to be able to connect and communicate as a start. Semantic: then the database data that says things like name, address, allergies, medical history, etc. may not line up from one DB to the next meaning that even if the data can actually move between the two systems, it may not be able to be interpreted once it gets there. Organizational: the doctors, patient registration people, customs and social norms, and a whole host of other problems may interfere. And then you have the legal: privacy of data regulations, digital identity rules, insurance rules & regs, etc. etc. etc. will all play a role.

So this is a more complicated definition and set of implications than what I have been talking about. I contend that our more simplified definition encompasses all of this, but that is for a different posting.

Here is the most interesting part that was a real AHA!-moment for me.

Each of those different layers are progressing at different rates. In the time it takes to address a legal/policy issue of national health care systems, the organizations may have shifted 3 times, the semantics may be the same as they were 30 years ago but now "simplified" with different schemas, and the technology underpinnings for interop may have changed 30 times.  This difference in time-to-solution considerations is the primary reason why mandated procurement, or mandated lists of standards to solve interoperability will ultimately fall short. 

To me, it seems that you want the maximum amount of neutrality and flexibility in the tech and semantic arenas while engaging heavily in the harder discussions around orgs and legal concerns.

I am not advocating that we get into a massive definitional battle over interop, rather that we start to think deeply about what it is we are trying accomplish around this topic and what the real moving parts are in the discussion so we can address them intelligently.  

Thank you Andreas Ebert for your insight on this, really deep stuff and I am most certainly going to chewing on it for a long time to come.