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Interoperability Week 4 Discussion Questions

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Interoperability Week 4 Discussion Questions

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1) How does interoperability impact your current nursing practice? Can you think of a time where inadequate system communication negatively impacted patient care?

2) What are some incentives for improving interoperability in healthcare? Do you foresee any changes or improvements in the future?

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The State of Interoperability in Healthcare

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The State of Interoperability in Healthcare

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Forbes

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Even as the healthcare information technology (IT) field has made strides to facilitate cooperation between EHRs (electronic health records), it's become abundantly clear that we still have a way to go to achieve anything approaching complete and total interoperability.

All attempts at interoperability must inherently begin by recognizing the starting point that makes everything so tricky: EHRs consist of a series of disparate systems built in silos that are suddenly being asked to work together for the good of the patient.

That's a tall order, although not an impossible one. Right now, much of the focus is on application programming interfaces (APIs), not surprising given the fast healthcare interoperability resources (FHIR) standards developed and proposed by Health Level 7 (HL7).

We're only at the very beginning of this journey, which is somewhat disappointing given the work that's already been put in. A recent study revealed that just shy of 30% of hospitals were able to meet the four key metrics necessary for true interoperability: data integration, reception, distribution and finding. Even more alarming? These 2017 numbers were up from just 24.5% three years earlier, which means that only one in 20 hospitals attained interoperability in that time.

As these numbers make abundantly clear, many hospitals remain out in the cold when it comes to the successful sharing of patient health information. While some of our nation's leading providers have embraced interoperability and embarked on exciting pilot projects and unprecedented methods of communications, others remain woefully underequipped for the challenges that lie ahead.

Let's get one thing straight: This isn't necessarily the fault of providers. Until relatively recently, facilities have not been properly incentivized to make interoperability a priority. It's only now, in an era of value-based care where every aspect of an organization is being scrutinized like never before, that administrators are starting to rethink whether the systems they have in place act as a hindrance to overall care.

We as healthcare IT providers are hardly blameless. For decades, the focus was on the creation of walled gardens, closed platforms that didn't play well with others. Hospitals didn't have the choice to invest in an EHR that communicated openly with other EHRs; they simply sought the best system possible for them and their patients.

Restricted somewhat due to Health Insurance Portability and Accountability Act (HIPAA) regulations, competition and the very nature of the current system, healthcare as a whole finds itself in quite a predicament. While tech developers in other industries continue to come up with apps, software and hardware that create entirely new sectors of business, healthcare struggles to garner the widespread adoption necessary to simply ensure that providers are able to successfully communicate with one another.

Is it any wonder, then, that companies like Apple and Amazon are swooping in with new approaches that put patient data in the hands of the patients themselves? We shouldn't be surprised at the popularity that these notions have engendered within the population. Consumers have become tethered to their smartphones, using them as conduits for handling the vast majority of their personal and professional affairs. It makes sense that they would want the same kind of access to their patient data.

We in healthcare IT need to recognize the call for interoperability and answer it with innovative ideas. Forget thinking outside the box; we need to nuke the box into the Stone Age and move on to the next big thing.

The good news is that when I look around our field, I see so many professionals more than up to the task. Today's tech leaders aren't content with ensuring hospitals are able to communicate with one another. At my company, and at so many others -- including heavy hitters like Cerner (an Ensocare partner), Epic and the VA, but also lesser-known startups that are just breaking through -- the focus is on deep-dive, predictive analytics set to usher in a new era of data-based care. It's also on wide-ranging tools that tap into every aspect of the clinical experience and deploy insightful, immediate diagnostic suggestions to physicians on robust, multi-function care delivery systems that create a patient experience unlike any we've seen before.

The state of interoperability right now isn't fantastic, but it's changing quickly. At the Health Information and Management Systems Society's 2018 conference (HIMSS18), I watched as our industry's best and brightest took the stage to share some of the most exciting tech developments I've ever seen, and I've been in this business awhile. There's a willingness to cooperate and a willingness to engage in these problems that is unlike anything I've witnessed before.

We're definitely "getting there" when it comes to interoperability. We have a long way to go, but I have no doubt that the combination of entrepreneurial spirit, impactful clinical application and unprecedented teamwork will lead us into a bold new era of healthcare IT innovation.

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The State Of Interoperability In Healthcare

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Even as the healthcare information technology (IT) field has made strides to facilitate cooperation between EHRs (electronic health records), it's become abundantly clear that we still have a way to go to achieve anything approaching complete and total interoperability.

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Office of the National Coordinator for Health IT

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 Three Levels of Interoperability in Healthcare

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 Three Levels of Interoperability in Healthcare

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Healthcare may have been among the last industries to automate, but the sector has made up for lost time.

Indeed, electronic data and healthcare IT (HIT) systems have expanded rapidly in recent years. But technical innovation has developed in isolated pockets. The first wave of HIT development took place in the billing and claims departments. Localized development of ancillary clinical systems such as laboratory, radiology, and pharmacy followed the rollout of administrative systems. More recently, the healthcare industry's focus has shifted to electronic health record (EHR) systems.

Those various healthcare systems, for the most part, have evolved independently of one another and continue to exist, for the most part, as islands of automation. Understandably, communication ranks among the most pressing technology issues the healthcare community faces today. Bridging the communications gap has become hugely important. As healthcare institutions continue to launch systems to improve patient outcomes and bolster operational efficiencies, the need for those systems to communicate will only grow. In addition, communication is central to emerging healthcare business and care delivery models. Accountable care organizations (ACOs) and patient-centered medical homes (PCMHs), for instance, depend on the ability to share data among primary care physicians, specialists, hospitals and payers.

Interoperability is the technology anecdote for the lack of communication among disparate systems. This field encompasses multiple tiers of communication that healthcare managers need to understand.

What is Interoperability?

The Healthcare Information and Management Systems Society (HIMSS) has developed a definition of interoperability , which the organization describes as "the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged."

HIMSS asserts that data exchange schema and standards should allow for the sharing of data among healthcare community participants irrespective of which applications or vendors they use. Interoperability, according to HIMSS, enables HIT systems to transcend organizational boundaries and promote effective healthcare delivery.

Foundational Interoperability

The HIMSS interoperability definition is set forth in a three-tiered model. The first layer is foundational interoperability. In this layer, interoperability lets the data transmitted by one HIT system to be received by another. This tier, however, does not require the system on the receiving end of the transmission to interpret the data. One can think of foundational interoperability as serving as the base of a communications pyramid, offering the most basic of data exchange services.

Structural Interoperability

As the middle layer, structural interoperability defines the format of the data exchange that takes place between systems. This level basically focuses on the packaging of the data via message format standards. Specifically, structural interoperability defines the syntax of the data exchange, according to HIMSS. Messaging standards such as Health Level 7, for example, provide guidance on how messages should be structured.

HIMSS notes that this form of interoperability, which is also known as syntactic or technical interoperability, permits the "uniform movement" of health data from system to system where the "clinical or operational purposes and meaning of the data is preserved and unaltered."

But since the content of a structured message may not be standardized, higher levels of understanding between systems is typically impossible.

Semantic Interoperability

Semantic Interoperability resides at the top of the communications pyramid. HIMSS defines this layer of interoperability as the ability of systems to both exchange and use the information that has been transmitted. In this case, the structured message contains standardized, coded data. This allows the receiving HIT system to interpret the data.

In the healthcare sector, semantic interoperability is critical for bridging the terminology gap among divergent HIT systems and data sources. This capability aims to create a common vocabulary that enables accurate and reliable machine-to-machine communication.

Data normalization is seen as foundational for semantic interoperability. The scattered, isolated HIT systems that have evolved over the years employ a range of medical terminologies. The lack of standardization among terminologies represents a key barrier to semantic interoperability. Data normalization, however, offers the ability to map between different terminologies and conflicting standards. A data normalization solution allows for apples-to-apples comparisons of information from different systems by 1) standardizing local content to terminology standards and 2) semantically translating data between standards to eliminate any ambiguity of meaning.

Breaking the Barriers

Data normalization and semantic interoperability can help healthcare organizations break down the barriers that block meaningful communication among HIT systems. What are your key interoperability issues? Leave your comments below.

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Understand the Three Levels of Interoperability

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Healthcare may have been among the last industries to automate, but the sector has made up for lost time. Indeed, electronic data and healthcare IT (HIT) systems have expanded rapidly in recent years. But technical innovation has developed in isolated pockets. The first wave of HIT development took place in the billing and claims departments.

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"Our industry's most overlooked problem"

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How to understand interoperability—our industry's most overlooked problem