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Office of the National Coordinator for Health IT

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      Interoperability                              The pace of interoperability in healthcare has quickened over the last decade.   Healthcare is in the advantageous position of being able to learn from other industries.  Social media, business and finance are already using technology for sending and receiving data in a usable format worldwide. Healthcare Information and Management Systems Society (HIMSS) defines interoperability as the sending and receiving of healthcare data within a system or within numerous systems with the goal of optimizing patient care. To the healthcare team, interoperability means that no matter where a person seeks care, the health information associated with that person will be accessible to ensure best decisions are made for the best price. For this endeavor to be successful standards for communication and protection of private health information need to be in place and policies for regarding the use required with in the United States and internationally.                                                                             Interoperability has been divided into three levels: foundational, structural and semantic. The lowest level is foundational. This is the process by which basic data is sent and received, but without interpretation. An example of this would be faxing a document or scanning a paper consent into a patient’s electronic chart. The next level of interoperability is structural. At this level the format or structure of data is dependent on the message or data being sent.  Sending lab results from one system to another demonstrates this level of interoperability.  The highest level is semantic interoperability. At this level interpretation of data sent from one system to another can be done.  Sending lab results from one lab to another health system with different normalized values and altering the date to represent the same interpretation of information referenced to the norms in the receiving system is an example at this highest level. This highest level provides the best sharing of information to coordinate care, to save money and to improve outcomes.                                                                                       Promoting the semantic interoperability is one way that advances can be in made in the health care in the United States. The U. S. Office of the National coordination for Health Information Technology (ONC) set goals for the ten-year period following 2015.  The first goal was focused upon the ability to send, receive and interpret data to improve quality and outcomes. This is the area of improvement currently in process. The second goal is to use the data set to save money based on clinical outcomes reviews. There are some health systems already creating guidelines and tool kits to improve care and now they are moving onto the financial side of decreasing costs. The final goal will be the creation of a national exchange of data with the capability to analyze and learn from the data obtained to continue improving the quality of healthcare, outcomes and to lessen the amount of money being poured into the health care system in the United States.                                                                                             Implications for Research and             Advanced Nursing Practice              In the nursing world, interoperability of shared healthcare information is extremely important.  Nurses must look back at previous hospital admissions to gain information and provide better care for the current admission. Having a working electronic health care system allows patient information to be shared among hospitals, physician’s offices, and pharmacies so that patients obtain the best care and are not tested or charged unnecessarily. Based on the review of several articles, patients are being charged unnecessarily for repeat testing when admitted to the hospital due to the hospital either; not having access to previous testing information or not requesting previous testing and admission information. If interoperability is made a priority in relation to shared healthcare information, the physicians could also cut down on system abuse by patients who seek unnecessary treatment as well as unnecessary medication administration. Every person within the healthcare system will benefit from the consistency and continuity of access to electronic health care information. Nurses benefit greatly from access to this information as well as physicians by contributing greatly to patient satisfaction and continuity of care. Consideration can also be made in regards to access to more advanced care for patients who need experts that are not available within their area of residence. As healthcare information technology expands, it provides the opportunity for open doors for advancements such as telehealth. Telehealth allows patients to have access to specialists all over the globe for a minimal price. It also allows local physicians, caring for that patient, access to expert consultation when needed.                                            In the future when all the healthcare information of the nation is compiled, it will be a rich source for research. Current guidelines and protocols for care of high risk obstetric patients are being created using the State databases from Washington, Oregon, and California. The California Maternal Quality Care Collaborative started the process and now it is spreading. Mining the data for cutoff blood pressures that are aligned with increased risk of stroke or seizure in Pre-Eclampsia or Eclampsia could only have been done because of the massive database previously generated. It is exciting to think about the level of research that can occur in so many other specialty areas or high risk events.                                                                   Conclusion	                As a nation, we are well on our way to completing the first goal of interoperability, that is the ability to for data to be shared between different health systems. Currently there is work being done to create objective outcome measures to evaluate progress. It is important to see even this first step as a great move forward. Sharing information between providers and health systems reduces redundancy of care and creates a more collaborative view of the patient with the patient at the center of the data with access to his or her own medical information. As a nation moving to the second and third goals of interoperability, cost reductions and improved outcomes will be seen. The next level would include a warning system that would be triggered when certain combinations of data are present in an electronic health record. Having these best practice advisories to remind the healthcare team of possible concerning trends is the future of healthcare informatics only possible with the highest levels of interoperability.

# data[].attributes.subject
      Interoperability                              The pace of interoperability in healthcare has quickened over the last decade.   Healthcare is in the advantageous position of being able to learn from other industries.  Social media, business and finance are already using technology for sending and receiving data in a usable format worldwide. Healthcare Information and Management Systems Society (HIMSS) defines interoperability as the sending and receiving of healthcare data within a system or within numerous systems with the goal of optimizing patient care. To the healthcare team, interoperability means that no matter where a person seeks care, the health information associated with that person will be accessible to ensure best decisions are made for the best price. For this endeavor to be successful standards for communication and protection of private health information need to be in place and policies for regarding the use required with in the United States and internationally.                                                                             Interoperability has been divided into three levels: foundational, structural and semantic. The lowest level is foundational. This is the process by which basic data is sent and received, but without interpretation. An example of this would be faxing a document or scanning a paper consent into a patient’s electronic chart. The next level of interoperability is structural. At this level the format or structure of data is dependent on the message or data being sent.  Sending lab results from one system to another demonstrates this level of interoperability.  The highest level is semantic interoperability. At this level interpretation of data sent from one system to another can be done.  Sending lab results from one lab to another health system with different normalized values and altering the date to represent the same interpretation of information referenced to the norms in the receiving system is an example at this highest level. This highest level provides the best sharing of information to coordinate care, to save money and to improve outcomes.                                                                                       Promoting the semantic interoperability is one way that advances can be in made in the health care in the United States. The U. S. Office of the National coordination for Health Information Technology (ONC) set goals for the ten-year period following 2015.  The first goal was focused upon the ability to send, receive and interpret data to improve quality and outcomes. This is the area of improvement currently in process. The second goal is to use the data set to save money based on clinical outcomes reviews. There are some health systems already creating guidelines and tool kits to improve care and now they are moving onto the financial side of decreasing costs. The final goal will be the creation of a national exchange of data with the capability to analyze and learn from the data obtained to continue improving the quality of healthcare, outcomes and to lessen the amount of money being poured into the health care system in the United States.                                                                                             Implications for Research and             Advanced Nursing Practice              In the nursing world, interoperability of shared healthcare information is extremely important.  Nurses must look back at previous hospital admissions to gain information and provide better care for the current admission. Having a working electronic health care system allows patient information to be shared among hospitals, physician’s offices, and pharmacies so that patients obtain the best care and are not tested or charged unnecessarily. Based on the review of several articles, patients are being charged unnecessarily for repeat testing when admitted to the hospital due to the hospital either; not having access to previous testing information or not requesting previous testing and admission information. If interoperability is made a priority in relation to shared healthcare information, the physicians could also cut down on system abuse by patients who seek unnecessary treatment as well as unnecessary medication administration. Every person within the healthcare system will benefit from the consistency and continuity of access to electronic health care information. Nurses benefit greatly from access to this information as well as physicians by contributing greatly to patient satisfaction and continuity of care. Consideration can also be made in regards to access to more advanced care for patients who need experts that are not available within their area of residence. As healthcare information technology expands, it provides the opportunity for open doors for advancements such as telehealth. Telehealth allows patients to have access to specialists all over the globe for a minimal price. It also allows local physicians, caring for that patient, access to expert consultation when needed.                                            In the future when all the healthcare information of the nation is compiled, it will be a rich source for research. Current guidelines and protocols for care of high risk obstetric patients are being created using the State databases from Washington, Oregon, and California. The California Maternal Quality Care Collaborative started the process and now it is spreading. Mining the data for cutoff blood pressures that are aligned with increased risk of stroke or seizure in Pre-Eclampsia or Eclampsia could only have been done because of the massive database previously generated. It is exciting to think about the level of research that can occur in so many other specialty areas or high risk events.                                                                   Conclusion	                As a nation, we are well on our way to completing the first goal of interoperability, that is the ability to for data to be shared between different health systems. Currently there is work being done to create objective outcome measures to evaluate progress. It is important to see even this first step as a great move forward. Sharing information between providers and health systems reduces redundancy of care and creates a more collaborative view of the patient with the patient at the center of the data with access to his or her own medical information. As a nation moving to the second and third goals of interoperability, cost reductions and improved outcomes will be seen. The next level would include a warning system that would be triggered when certain combinations of data are present in an electronic health record. Having these best practice advisories to remind the healthcare team of possible concerning trends is the future of healthcare informatics only possible with the highest levels of interoperability.

# data[].attributes.body
Blackman-Lees, S. (2018). Towards a conceptual framework for persistent use:  A technical plan to achieve semantic interoperability within electronic health record systems. Hawaii International Conference on System Sciences. Retrieved from http://hdl.handle.net/10125/50440

Dzau, V., & Ginsburg G. (2016).  Realizing the full potential of precision medicine in health and health care. JAMA, 316(16). doi:10.1001/jama.2016.14117

Evermann, J. (2005). Towards a cognitive foundation for knowledge representation. Information Systems Journal, 15(2), 147-178. doi:10.1111/j.1365-2575.2005.00193.x

Eysenbach, G. (2016). Challenges and opportunities of big data in health care: A systematic review. JMIR Medical Informatic, 4(4). doi: 10.2196/medinform.5359

Healthcare Information and Management Systems Society (2019). Interoperability toolkit.  Retrieved from https://www.himss.org/library/interoperability-standards/toolkit

Krumholz, H., Terry, S., & Waldstreicher, J. (2016). Data acquisition, curation, and use for a  continuously learning health system. JAMA: Journal of the American Medical

Association, 316(16). Retrieved from

http://ejournals.ebsco.com.ju.idm.oclc.org/direct.asp?ArticleID=4F0899CA406A2D2B1B34

Peixoto, H., Domingues, A., & Fernandes, B. (2016). Steps toward interoperability in healthcare environment. Applying business intelligence to clinical and healthcare organizations.    Retrieved from http DOI: 10.4018/978-1-4666-9882-6.ch001

Sewell, J. (2019). Informatics and nursing: Opportunities and challenges. Philadelphia: Wolters  Kluwer.

Soualmia, L., &  Charlet, J. (2016). Efficient results in semantic interoperability for health care findings from the section on Knowledge representation and management. Yearbook of  Medical Informatics 25(1).

# data[].attributes.headline
 Hawaii International Conference on System Sciences. Retrieved from http://hdl.handle.net/10125/50440

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 Hawaii International Conference on System Sciences. Retrieved from http://hdl.handle.net/10125/50440

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How can data be used to save money? Interoperability!

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How can data be used to save money? Interoperability!

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1.  What ways have you seen interoperability improve healthcare in your workplace?

2.  What concerns or risks are associated with interoperability and its associated research

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How can information technology save lives? Interoperability!

# data[].attributes.subject
How can information technology save lives? Interoperability!