Key Takeaways
- According to the ONC, the definition of healthcare interoperability is a system’s ability to exchange health information and utilize it from other systems. An interoperable system performs these tasks without any user intervention.
- The HIMSS developed a multi-level framework to assist medical personnel in evaluating their data exchange and document management capacities. It consists of: the foundational level, structural level, semantic level, and organizational level.
- HIE is part of an architecture that connects multiple applications and enables them to transfer data. It helps an organization integrate interoperability without having to face instrumental cost problems.
Table of Contents:
- Challenges of Working with Data Influx
- What is Interoperability?
- Levels of Interoperability in healthcare
- Understanding Interoperability in Healthcare
- Applications and Interoperability
- Example of Interoperability in Healthcare
- Understanding Standards and Interoperability
- Health Information Exchange (HIE)
- ONC’s National Strategy
- The vision of Interoperable Health IT
- Interoperable Business Capabilities
- The Interoperability Landscape
- A Closer Look At Excess Spending
The amount of data in the healthcare ecosystem keeps on expanding. Patient data is generated and distributed from a multitude of locations inside a healthcare facility. These locations include labs, test sites, in-house devices and more. Sharing this data across many disparate systems is critical to ensuring successful care of individual patients.
Challenges of Working with Data Influx
Since there is so much data influx across healthcare networks, challenges emerge when managing and sorting this data. Data is transmitted through a vast variety of numbers and formats. For example, HL7V2, FHIR, and CDA, are just some of the data formats available.
Sharing data between systems, especially if they are stored in different formats, can be difficult. This is because not all systems support different formats. Moreover, integrating these systems with the ability to perform one-to-one data sharing can be difficult and time-consuming.
A second challenge arises when a particular system represents data differently when it is in a different format. There are several coding systems such as SNOMED, CPT, LOINC, or ICD-10. Each coding system may present a distinct way to display a database stored in a different format.
Sharing results between systems that are coded in different ways is, therefore, challenging. This is because translation is required for the integration of each data. For example, you can find more than 450 blood pressure coding entries in LOINC.
In this situation, translating a particular LOINC code that captures an observation or test to CPT can be complicated. Without a proper integration system and data transformation into a consistent format, the data can become isolated. This can lead to important health information being missed by professionals. This can, in turn, put a patient’s health at risk.
What is Interoperability?
To stem away from the complicated jargon, interoperability is simply when devices work together effectively and efficiently. You have to keep in mind that interoperability does not only apply to devices. Instead, it allows devices, systems, and people to work together.
The place where a device meets a system is the interface. That interface is what dictates the regulatory aspect of interoperability. It sets the roles and responsibilities of the system and decides how the information will be exchanged in a particular interface.
Levels of Interoperability in healthcare
The HIMSS (Healthcare Information and Management Systems Society) Board developed a multi-level framework to assist medical personnel in evaluating their data exchange and document management capacities. The framework consists of four levels of interoperability: the foundational level, structural level, semantic level, and organizational level.
1. Foundational Level
Foundational interoperability (also known as simple transport) creates the foundation for healthcare data exchange between disparate systems by defining the integration and compatibility criteria required to share and exchange data.
At this level, various software platforms and DMS (Document Management Systems) can securely communicate and transfer data with each other. However, they are unable to interpret patient data without the help of humans or other technologies.
2. Structural Level of Interoperability
Structural Interoperability in healthcare (also known as Structured Transport) is the way medical information is organized and transmitted. By standardizing the data, document management systems can automatically identify and interpret pre-defined data fields while preserving the clinical or operational meaning and purpose of the data.
Electronic Health Information (HIE) standards like FHIR or HL7 provide actionable steps for healthcare organizations to attain structural interoperability. It also ensures that healthcare data exchange remains uniform, centralized, and easily transferable between systems.
3. Semantic Level
Semantic transport, or semantic interoperability, is the ability of two or more interoperable systems to exchange, interpret, and leverage information. The data is standardized and codified to ensure that the exchanging systems share a common understanding of the semantic value of a single concept, such as a specific procedure, diagnosis, or laboratory result.
4. Organizational Level
Organizational interoperability represents the utmost level of seamless sharing and understanding of patient data among diverse organizations, each with its own distinct objectives, regulations, and demands.
Attaining this degree of interoperability necessitates a thorough consideration of non-technical factors, including policy, legal, social, and organizational elements, due to the involvement of multiple stakeholders, entities, and individuals. By encompassing both technical and non-technical factors, it becomes possible to collaboratively utilize shared data across and within organizational boundaries.
Understanding Interoperability in Healthcare
According to the Office of the National Coordinator (ONC), the definition of healthcare interoperability is a system’s ability to exchange health information and utilize it from other systems. An interoperable system performs these tasks without any user intervention.
Electronic health information is one of the most critical datasets. Thus, the transmission of these datasets should be efficient and reliable. In health care, different compatible information technology systems and software applications must efficiently communicate with each other. They should have features that allow them to work collectively for reliable patient data delivery for healthcare professionals and patients.
Interoperability within an Organization
A hospital’s IT systems communicate with each other and share data to improve care and efficiency. When it comes to data within an organization, it can include simple messages and indications that carry huge implications. These can include messages that inform patients about admissions, tracking medication orders or lab results.
A patient administration system is a network that hospitals use within their organization. It records all patients’ admissions and transmits this message across all departments inside the hospital, such as pharmacy, laboratories, and hospital’s data warehouse.
On the electronic health record, or the EHR, a doctor may record a lab order, and the lab order would then flow to the systems inside the laboratory and the data warehouse. An EHR or electronic health record is an all-encompassing system that records a patient’s health information.
Therefore, the smooth and seamless flow of data across different systems inside a hospital is an example of interoperability within an organization.
Interoperability between Organizations
Interoperability between different organizations happens on a much larger scale. It is unlike the simple flow of data across different departmental devices. Instead, it involves the comprehensible communication of various interfaces that share data in different formats.
Due to this, interoperability takes a much vast and complex shape. For instance, you can imagine a doctor writing a prescription for a medication. That prescription flows electronically to the community pharmacy. Staff members require permission to fill this medication at the pharmacy and authorize its payment.
They will then have to request authorization from the insurance company. The insurance company will then respond with the approval of that authorization. This exchange of data and communication is not possible without an interoperable system that works between organizations.
In another scenario, a doctor may want to refer their patient to another doctor. The doctor would then create an electronic care summary. This summary will then flow to the EHR of another doctor. Sometimes doctors also require sending lab tests of patients to one another.
This helps the patient save time and cost, as someone who visits different specialists does not require giving blood samples in all visits. Another interoperability use case that is essential between organizations pertains to immunization. Immunizations are very important for the public health department.
After immunization shots, a message may electronically flow to the interfaces of public health authority. This allows them to track down every individual’s immunization.
Applications and Interoperability
Integrating different applications to work together will ultimately involve creating bi-directional connections. This means they need an intervening system that translates one code to another whenever there is a data transfer. By doing this, a system will be able to read and store a data format from a completely different source.
However, when you add additional applications and have them work together, you need to maintain more bi-directional connections. Additionally, if one application happens to change, all the other applications will need to change as well, as they are now connected.
Not to mention, making changes for each application addition and update is a costly endeavor. The solution for this problem is standards and interoperability.
Example of Interoperability in Healthcare
Interoperability in healthcare is a concept that is more easily comprehended when considering real-world scenarios. For example, imagine that a patient visits your clinic with their health records from a local hospital. With interoperability, the patient’s electronic health records can be accessed with the press of a button, thus reducing the amount of time spent discussing past treatments and medications.
After the appointment is concluded, the health records can be sent to other departments within the clinic to initiate tests or treatments. For example, if the patient requires infusion therapy, a nurse can receive the EHR and ensure that the desired dosage of medication is programmed into the infusion pump. This process can be completed in a matter of seconds.
Finally, after the patient has been treated, the billing phase begins, with staff entering medical codes for each service provided and preparing claims. All data is then shared automatically and sent to the patient’s insurance carrier for payment.
Interoperability in healthcare involves the exchange of data in the healthcare system at all stages of a patient’s treatment journey. This makes it as seamless as possible, regardless of whether the clinical data is being transmitted between a clinic’s departments or to various healthcare institutions.
This is a basic instance of interoperability, however, its applications can be much more varied and inter-organizational, which is why standardization and data formats are so integral to interoperable systems.
Understanding Standards and Interoperability
Standards refer to a set of rules. In software and IT, these rules can dictate how information flows consistently and uniformly across all applications. To maintain standards, there needs to be an authoritative organization that approves the transmission of data from one system to the next.
Therefore, by setting standards, developers can allow data exchange between two different systems by allowing them to communicate using a specific set of standards. This will allow the two systems to understand each other with the help of a common set of criteria.
Therefore, standards can help enable interoperability between different systems. Standards that help applications adhere to a common language or vocabulary are known as semantic standards. The semantic standard allows two applications to use similar terms when sharing information on patient data.
However, using similar terms is not enough. The application interface and software must have common grammar to make sense of the terms. Standards that help with this are syntactic standards. They help systems determine how each term fits together. With semantic and syntactic standards, the tow applications can share data seamlessly without human intervention.
Thus, investing in standards makes enabling interoperability more cost-efficient between all digital health applications. To ensure interoperability in healthcare, health operators need to equip their systems with a component known as the HIE, or health information exchange.
Health Information Exchange (HIE)
HIE is part of a country’s enterprise architecture that connects multiple applications and enables them to transfer data. It uses a bundled standards function and provides implementation guidance for healthcare software developers.
Using this approach helps an organization integrate interoperability without having to face instrumental cost problems. HIEs work by storing lists of different terminologies and concepts. After doing that, it maps how each term and lists relate across various applications.
Thus, with the framework of standards in place, HIE uses all the lists and terms to make real-time translations. This enables multiple applications to communicate through HIE. Standards make this mapping process easier. The HIE acts as an intercepting body, through which all data travels during a transition.
When the HIE receives data from each application, it keeps track of all the relations between them. Once it processes the difference between programming languages, it will translate the data to the appropriate language in real-time before sending it to the application at the receiving end.
In other words, the HIE acts as a central translation, establishing a standard between data transfers and enabling interoperability. Any new application integrated into the system only needs to communicate with the health information exchange. On the other hand, any changes in the application will require the HIE to undergo the updates and not the applications.
ONC’s National Strategy
The United States plans to issue a national strategy for health care interoperability across the nation. They wish to build an interoperable ecosystem that supports the concept of a learning health system. Read this report by ONC to learn more about the learning health system. In short, it refers to a nationwide interoperability roadmap for all health care institutions.
The vision for an interoperable health IT system allows health care providers consensual access to patient data. This means that a healthcare provider will gain access to patient data regardless of its first collection.
This will rid the chances of any delay in care and make the health care process faster and efficient. It will mean that a health care facility will no longer have an excuse to hold up your care because they do not possess the right data.
With this nationwide strategy, technology will help healthcare providers successfully communicate and actively collaborate to provide you the appropriate facilitation. When this comes to fruition, you will have interoperable health IT applied to real care coordination.
It will also embody a healthcare system where the patient can access your medical record and make changes to them in real-time. Not only that, you will also be able to share your healthcare data with others. Ultimately, as a patient, you will have control over your healthcare data.
With a source that will allow interoperable exchanges of data, clinicians and patients will be able to set appointments online through telemedicine. Your caregiver will also be able to access your records instantly and use the valuable health information to advocate for your care. This is an example of how interoperable health IT will be able to support real patient-centered care.
Outbreak Prevention
Having a unified interoperable system will also effectively prevent outbreaks. This is because it can analyze collective information from all sources and put it into analytical data. Doing so will offer insights over public health safety and allow governments to manage the health of the masses more effectively.
It will also allow them to anticipate the outbreak beforehand and take early steps to prevent any lasting damages. This is because they will have real-time health changes. Since an interoperable system will allow authorities time to develop a prevention strategy, they will be able to deal with outbreaks cost-effectively.
In other words, it will allow clinicians and health care authorities to make decisions that are informed and based on legitimate real-time data. Interoperable health IT is an essential foundation to a learning health system.
Learning Health System
A learning health system refers to an ecosystem of patient data. In this ecosystem, all patients and clinicians are stakeholders, and they have the right to their data. They can transmit information in this ecosystem and contribute to it by feeding new insights over the data. The interoperable health IT aims to strengthen the foundations of the learning health system.
The vision of Interoperable Health IT
To briefly explain the vision of interoperable health IT, it refers to supporting a fully coordinated patient-centered care. With maximized interoperable procedures, patients and healthcare individuals can have information that offers better care.
This is because it integrates better coordination within caregivers. Not only that, but it also allows for more extensive and updated patient data to clinicians. This leads to a better diagnosis by the healthcare practitioners and high level care for the patients.
Additionally, due to relevancy and transparency of data, you will have better patient and caregiver engagement. This is because caregivers will have timely access to data to support each other. Healthcare individuals will also be able to contribute their personal data to a patient’s record and share that with the patient’s caregivers.
Overall, the healthcare facility will be able to provide much more value to the patients. Not only that, you, as a patient, will experience a much smoother and seamless workflow in healthcare facilities. There will also be noticeably fewer delays and less redundant work for healthcare providers. These advantages will also help you save money and take better care of your health.
The Jason Group introduced a report in April 2014. This group consists of scientists who also act as health advisories for the federal authorities. This report was integral for the ONC’s interoperability goal. The Jason report listed a number of benefits for interoperable health IT. Here are some benefits:
- Interoperable health IT allows patients to access their personal health information easily
- It delivers patient records swiftly
- Reduce the chances of errors in the patient records
- Limit diagnostic procedures, repeated testing, and unnecessary diagnosis. By doing so, it saves the time of patients and healthcare providers
- Produces health records that are extensive, complete and precise
Interoperable Business Capabilities
The interoperability handbook is a report that was published in September 2015. This report unveils the benefits of interoperability from the perspective of the provider. Equipped with an interoperable system, providers will have the ability to have patient information ready for the doctors.
They will also receive automatic alerts and notifications about any changes in the records of the patients. This will help providers make the right decision in regards to patient care. As a healthcare provider, it will also allow you to offer care remotely.
This means that the practice of telemedicine will become much more effective and optimized. Telemedicine refers to clinical checkups, diagnosis, and health care treatments through a virtual medium. In this, a patient and a doctor have to engage through a virtual platform instead of physically.
Doctors analyze patients much more effectively during virtual visits with interoperable healthcare data in place. Providers will also be able to use technology to understand any outbreak that happens to occur. Once they know what is happening and where it is happening, they can provide healthcare equipment more efficiently.
The Interoperability Landscape
Interoperability comprises of many different vendors, players, and definitions that make up the ecosystem. In the future, the interoperability landscape will contain different transitions of care. In other words, there will be various data-sharing networks such as HIEs, HINs, HHS, and more.
Essentially, there will be different platforms that will allow patients to transfer data from different care settings. You will also have different protocols within the ecosystem. One example of a protocol is direct trust, which allows various providers to exchange messages.
Similarly, you also have common well or care quality. These are networks of healthcare providers that you can utilize for queries about healthcare information. You also have private companies such as Patient Ping. These networks notify each healthcare professional about the movement of patients from one care setting to another.
Additionally, you also have underlying software such as Medicity. They offer similar technologies that HIEs will utilize. What’s more, Medicity gathers information from different healthcare providers, standardizes them, and makes them available to share within each platform. This is an example of how the interoperability landscape will work.
In hindsight, it is all about how one data moves from care setting to another. It is not something that you will have to plug into if you wish to utilize the interoperability networks. Instead, this landscape is about how various health providers use, sort, and transfer electronic health records. The technologies will essentially help ease the process of patient data and safeguard the sovereignty of medical records.
A Closer Look At Excess Spending
Technology has accomplished many things but, it has not enabled a better healthcare environment for patients. According to statistics, 20 percent of GDP is being spent on healthcare. Excess spending in the healthcare industry revealed that about one-third of healthcare spending is wasted on unnecessary procedures, services, and administrative costs.
At its core, technology is something that people utilize to make functions more efficient. Technology adoption, however, did not come easy in the healthcare sector. Electronic health records back in 2008 were in an innovator bucket for a long time.
This is because the Government made the mistake of putting billions of Dollars into the hospitals and providers instead of improving healthcare technology. Thus, people missed the opportunity to have electronic health records in the cloud. A cloud-based record system will encompass a more scalable solution to on-premise infrastructure.
To Sum It Up
This concludes the overview of interoperability in the healthcare system. To summarize, the goal of having interoperability in healthcare is to build a health IT ecosystem that is scalable, changeable, efficient, and secure. It is an attempt to eradicate redundant and unnecessary expenses from healthcare tech.
Get get more information on interoperability in healthcare and to incorporate an interoperable system, get in touch with Arkenea, one of the leading healthcare software development companies in the USA.