Healthcare Interoperability

Why is interoperability in healthcare important?

Patient health and medical data has always been challenging to access and share in a secure
manner. It’s difficult to share because it’s sensitive and requires a high level of privacy and
security, yet the inability to access it when it’s needed has potential to cause significant harm. A
lack of interoperability can result in an incomplete understanding of an individual’s or
population’s health needs, which can lead to poorer outcomes and higher costs.

As the technology of medical and information advances, interoperability and data sharing are
going to become increasingly critical for delivering effective healthcare. In addition to helping
physicians and other healthcare providers see a more complete view of their patients, health
data interoperability helps organizations across the healthcare industry. If health information
systems were more integrated, then health plans would be able to develop a better
understanding of their utilization rates and demand for services. Government service providers
would be able to access population data to see trends and meet their citizens’ needs. Also, life
science organizations would be able to leverage robust datasets to drive faster, more informed
research.

With better interoperability, organizations would be able to stop regarding individuals as a

patient one day, a health plan member the next and a consumer of health apps the next.
Instead, decision-makers across the industry would be able start looking at how people access
and use health information, regardless of its source, to drive better models of care, pursue
better patient safety and improve experiences for the people they serve.

Healthcare interoperability benefits:

Better care coordination

With access to data, clinicians have an easier time accessing a patient’s most important health
information, which can lead to fewer repeat tests, prevent inadvertent treatment interactions and
reduce miscommunications.

Higher performance
When data can be combined more easily, it can also be analyzed more easily. Interoperability
makes it possible for organizations to study data trends, past performance and make data-
driven improvements in patient care and other areas.

Better experiences
Data interoperability can reduce the amount of redundant administrative work both within and
outside organizations, creating a more satisfying experiences both for employees and for those
they serve.
Health information exchanges and interoperability

Modern consumers have high expectations when it comes to accessing information, and many
now expect to have quick and continuous access to records about their health and care. That’s
why many healthcare organizations are building health information exchanges (HIE), which are
specialized networks that rely on interoperable systems to share electronic health information
seamlessly and securely.

Even though the adoption of EHRs was a good first step towards building HIEs, there are still
many challenges that need to be overcome to achieve the level of interoperability needed to
obtain the full benefits of HIEs. These challenges include:

Lack of standardization: Although standard record formats like FHIR and HL7 are becoming
more common and new regulations are pushing EHR vendors to provide APIs that support
interoperability, many providers and healthcare systems use customized EHR systems that can
be hard to convert to a standard format and shared with others.

Security: Healthcare organizations can find it hard to balance the need for health information to
be accessible with the need to secure sensitive information and maintain patient privacy,
especially with the increasing number of cybersecurity attacks on healthcare systems (PDF, 1.3
MB).

Consent: By building digital health systems in which health information flows freely from
provider to provider, it’s not always clear when patient consent is needed and what level of
consent is needed. Healthcare organizations are understandably cautious about this and tend to
error on the side of not sharing information.

Professional burdens: When new tools for recordkeeping are introduced, people need to learn
how to use them. Healthcare professionals are often wary about new systems since EHR
systems often do a better job supporting administrative and billing workflows than clinicians'
needs.

These challenges are not insurmountable. With advances in cloud computing, especially hybrid
cloud, it’s become easier for organizations to move and secure data in a consistent way. Cloud
environments provide opportunities for organizations to build data pipelines that standardize
data to an industry-standard format like FHIR and provide secure access to people who need it
– whether they’re payers, providers or patients themselves.

The challenges of interoperability in healthcare

While many healthcare experts and leaders agree that better interoperability would improve
healthcare overall, there are common challenges that healthcare organizations tend to face as
they work on making their data and systems more interoperable. Let’s explore those challenges
and how organizations can overcome them:

Disjointed coordination
Improving interoperability requires strong coordination between different organizations,
regulators and leaders as well as coordination within organizations. Regulators provide
standards and rules for healthcare organizations to follow but organizations that want to be
proactive about interoperability should consider creating a dedicated interoperability strategy
and make interoperability planning a priority.

Limited budgets
Not all organizations have the financial or technical resources they need to invest in the
technical resources needed to build a truly interoperable system. There may be some
government grants available to update health records systems, so organizations should check
to see if they’re eligible. Many cloud vendors also offer pay-as-you-go payment models that
could make technical expenses more affordable and predictable.

Diverse technology needs

Organizations need to follow different rules and regulations depending on what type of care they
provide and where they're located, so many organizations have highly customized data.
Organizations can help connect different internal and external systems through a hybrid cloud
platform that gives them options to combine and integrate their data without sacrificing the
customizations they need.

Legacy systems
Healthcare organizations with older legacy systems face the dual challenges of modernizing
their systems while also meeting interoperability requirements. Organizations can meet both
goals using a hybrid cloud approach to extract data from legacy systems and make it more
accessible for modern applications and programs. This approach gives organizations the option
to keep data moving while they work on updating their systems.
Levels of healthcare interoperability

Interoperability for healthcare has four different levels that have been defined by informatics
experts and the Healthcare Information and Management Systems Society (HIMSS). Some of
these levels can be achieved today with existing healthcare IT architecture and IT systems,
while others will require innovation and additional developments in patient-centered technology.

These levels include:

Foundational
This level of interoperability, also known as simple transport, is the most basic. Data is securely
transferred from one system or device to another without interpreting the data or transforming it
into a particular format. For example, a nurse downloads a PDF file of a patient’s latest lab
results from the lab’s results portal, then manually enters the data into the patient’s health
record.

Structural
When structural interoperability, or structured transport, is achieved, all the data is standardized
to a particular format so it can be interpreted by multiple systems or devices. This data is
organized in a particular order so the receiving system can automatically detect specific data
fields. Data standards like FHIR and HL7 provide structural interoperability so records can be
consistent, centralized and easy to move between systems.

Semantic
The semantic level of interoperability, or semantic transport, involves exchanging data between
systems with completely different data structures. Imaging systems provide a simple example —
there are many specialized DICOM and non-DICOM formats for images. With semantic
interoperability, images could be transferred from one system to another, interpreted and
incorporated into the new system regardless of the image’s original format or source. Yet
determining what data to collect and transfer can be difficult, since systems have different ways
of presenting the same information. For that reason, some experts argue artificial intelligence
will be needed to achieve full semantic interoperability.

Organizational
Organizational interoperability involves the seamless exchange of data between various
organizations with different requirements, regulations and goals. To achieve this level of
interoperability, there must be policy and governance innovations as well as technological
innovations to ensure consent, security and integrated workflows move smoothly between
different groups. Though some experts say semantic is the highest level of interoperability,
others say it is organizational interoperability.