Health data presents a paradoxical situation: its sensitivity requires high security and privacy, making it difficult to share, yet significant harm may arise if health data is inaccessible when needed. So, even though the adoption of electronic health records (EHRs) has exceeded 90% in outpatient and inpatient settings, health information exchange (HIE) has somewhat lagged behind. On top of that, less than 50% of hospitals are incorporating data received from outside providers into patient records despite having routine access to such data.
It’s evident that creating an integrated data ecosystem still requires a lot of work. Advancing interoperability is nevertheless a critical part of almost all healthcare activities ranging from emergency response to health equity. In this blog, we look into ways to further interoperability in pursuit of its considerable benefits.
What is Healthcare Data Interoperability?
Interoperability, as defined by the IEEE Standard Computer Dictionary, is the capability of components or systems to exchange data and use the exchanged information. It’s noteworthy that healthcare organizations can have HIE despite not having true interoperability, as HIE merely entails sharing information electronically. Meanwhile, the latter also requires the use of exchanged data.
How Does Interoperability Work?
Interoperability requires a syntactic approach, enabling two or more systems to adopt structure protocols and standard data formats.
The next step is using metadata to connect data elements to a shared and controlled vocabulary set. Once established, this vocabulary will link to an ontology. As a data model, an ontology comprises concepts and their relationships in a particular domain. Healthcare organizations can then send relevant information without depending on another information system by adhering to these standards.
Healthcare Interoperability Levels
The Healthcare Information and Management Systems Society (HIMSS), along with informatics experts, identified four different levels of interoperability for healthcare:
- Foundational: This “simple transport” level is the most basic. Organizations establish the interconnectivity requirements necessary to securely transfer data from one device or system to another without transforming it into a specific format or interpreting it. For instance, a nurse manually enters a patient’s lab results into that patient’s record after downloading the PDF file from the lab’s results portal.
- Structural: When organizations standardize data to a specific format so multiple devices or systems can interpret it, “structured transport” is achieved. These organizations would define the organization of data exchange, allowing receiving systems to detect particular data fields. Data standards such as HL7 and FHIR provide structural interoperability to render records centralized, consistent, and convenient to transfer between systems.
- Semantic: The “semantic transport” involves data exchange between systems having separate data structures. For example, imaging systems, wherein multiple specialized non-DICOM and DICOM formats exist, could transfer, interpret, and incorporate various images with semantic interoperability, regardless of each image’s source or original configuration. Yet, it can be hard to determine what data to gather and share since systems may present the same information differently. Some experts thus argue full semantic interoperability may require implementing artificial intelligence.
- Organizational: Organizational interoperability includes organizational, policy, governance, legal, and social considerations to facilitate the timely, secure, and seamless use and communication of data between and within individuals, entities, and organizations. While some experts consider the organizational level the highest level of interoperability, others say it is the semantic level.
Why Does Interoperability Matter?
As populations worldwide live longer, data sharing and interoperability are becoming increasingly vital for robust healthcare delivery. Interoperability assists clinicians in delivering effective, safe, and patient-centered care. It also enables caregivers and individuals to access electronic health information for coordinated and managed care.
With better interoperability, organizations can stop seeing individuals as health plan members one day, health apps consumers the next, and patients the next. Instead, decision-makers would be able to begin evaluating how individuals access and use health information from different sources to improve patient experiences, pursue better patient safety, and drive better care models.
Benefits of Healthcare Interoperability
- Better Care Quality: When clinicians can access real-time, comprehensive patient data, there can be a decrease in repeat tests, miscommunications, and inadvertent treatment interactions. In other words, medical practitioners can make more informed decisions with a complete picture of patient history.
- Improved Patient Experience: A more satisfying patient experience can arise from interoperability as redundant administrative work, both outside and within organizations, reduces. No longer will patients need to fill in forms repeatedly at each healthcare facility they visit. Patients can also take an awareness-based and active approach to their health while having 24/7 access to their medical history.
- Higher Efficiency: Operational inefficiencies can contribute to issues ranging from overstaffing to inadequate patient care, creating a drag on organizations. Interoperability makes it possible to eliminate task duplication, facilitate automation, and reduce those bottlenecks. Moreover, it helps organizations analyze past performance and data trends more efficiently, which leads to data-driven improvements.
Barriers to Healthcare Interoperability
Although EHR adoption was the initial step towards developing HIEs, organizations must overcome several remaining challenges to attain the interoperability level needed to enjoy the full benefits. These challenges are:
- Security: Especially with the rising number of cyberattacks healthcare systems encountered in recent years, it can be difficult for healthcare organizations to balance the need for accessible health information with the demand for patient privacy and data security.
- Lack of Standardization: Many providers and healthcare systems identify their patients using social security numbers, names, and birthdates. But this combination has no unified format, and not all medical facilities use this as an identifier. There can be little interoperability if there is no adequate agreed-upon method of referring to a patient. Customized EHR systems are likewise problematic as these require more time and effort to convert to a standard format for data exchange. And some providers still use these, albeit standard record formats such as HL7 and FHIR are becoming more common.
- Approval of Information Sharing Requests: The request approval and validation process needs to be regulated. Still, it’s not always apparent when patient consent is required and at what level for information to flow freely between providers in digital health systems. Being understandably cautious about this, healthcare organizations tend to err on the side of not disclosing information.
- Skills Gap: Small organizations may struggle to employ IT personnel with the necessary skills. Despite having more IT staff, larger healthcare organizations may still lack expertise in interoperability technologies and standards because their IT teams usually focus more on immediate operational problems. For many healthcare organizations, allocating IT personnel’s time to work on technical integrations can thus be a stretch.
How to Make Interoperability a Powerful Business Tool?
Adopt Standard Terminology
The first and foremost action item for healthcare organizations to manage interoperability is to evaluate their current adoption of standard terminology.
Legacy systems in healthcare are still widespread, although Microsoft has stopped supporting 70% of Windows medical legacy devices since 2020. These systems didn’t incorporate standard terminology or interoperability into their data model and would need retrofitting. Therefore, becoming interoperable usually begins with a time-consuming terminology mapping process. If one of your organization’s core practices is nonetheless keeping up with standard terminology, you’re in a much better position to capitalize on interoperability technology.
Develop an Inside-Out Strategy
An inside-out data strategy requires you to determine the deliverables you want from your data. You need to align your needs and goals to maximize the value of your data. It’s then that you can make decisions that result in optimal processes.
An inside-out strategy shifts the focus from relying on outside partners to first setting priorities internally. Once you’ve had a clear roadmap, you can amass multiple partners and vendors to execute large-scale projects more effectively, whether to deploy a data warehouse, optimize an existing EHR, or implement a new EHR system.
Manage IT Integration
Healthcare organizations need to pay attention to 2 aspects when building a data ecosystem:
- A data management strategy serves to ensure privacy and consistency. As you invest in data organization for interoperability purposes, you can likewise consider other healthcare applications of data to tap into.
- A data layer provides APIs supporting the integration of your partner’s data repositories. It must comply with common interoperability standards to avoid compliance and security issues.
Create a Reliable Patient Consent Process
Establishing a transparent consent protocol that encourages user participation can benefit your organization. An ideal protocol would have policies prohibiting data transmission or access in ways upon which patients did not agree. This consent protocol is to be company-wide.
Build Strong, Dedicated Teams
A strong team assures your organization has the required depth of expertise and skills, along with the processes needed for strong governance – including playbooks, implementation guidelines, and well-defined standard operating procedures. Healthcare leaders should build teams that look for ways to optimize operations across the entire organization. They should continuously invest in training and development programs for their teams as new technology trends emerge and evolve.
Finding the Right Healthcare Interoperability Partner
The right partner will help you implement effective interoperability solutions by bringing expertise in 4 areas:
- Data and analytics expertise
- Cybersecurity expertise
- Cloud expertise
- Interoperability advisory services
Need help with managing interoperability? Choose KMS Healthcare as your interoperability partner. A team of experienced developers can revolutionize research, testing, integration, and delivery. Contact KMS to learn more about our positioning as a top provider of healthcare interoperability solutions.
