As the healthcare field continues to shift toward the use of electronic health records, the need to develop a clear exchange between information systems has become vital. Pharmacies, private practices, hospitals and other healthcare organizations need to be able to exchange data in a way that is compatible across software and applications.
This can be done through interoperability, which is the ability of various systems and applications to exchange and analyze data.
In 2015, as part of the Medicare Access and CHIP Reauthorization Act (MACRA), Congress declared an objective to reach a “widespread exchange of health information through interoperable certified EHR (electronic health record) technology nationwide by 2018.”
What makes this so vital to the healthcare industry? If a California resident is visiting a relative in New York and falls ill, then the ability to transfer their EHRs across the country with one transmission could help other doctors formulate the best treatment plan, as they would have access to that patient’s medical history and current medications.
Achieving true interoperability can increase provider collaboration, patient engagement and assist in increasing better patient outcomes.
The Levels of Health Information System Interoperability
According to HIMSS, there are three levels of interoperability within the healthcare industry: foundational, structural and semantic.
Foundational gives the opportunity for one IT system to send data to another and does not involve the other system needing to interpret that data.
Structural is the intermediate level, and it “defines the structure or format of data exchange where there is uniform movement of healthcare data from one system to another such that the clinical or operational purpose and meaning of the data is preserved and unaltered.”
The highest level, semantic, means the ability of multiple systems to exchange information, and this level supports the electronic exchange of patient information to improve the efficiency, safety and quality of healthcare delivery.
The ONC’s Interoperability Roadmap
In 2014, the Office of the National Coordinator for Health Information Technology published a comprehensive roadmap outlining its plans for improving health IT interoperability in certain time increments.
Within this plan are 10 guiding principles for nationwide interoperability, which are:
- Focus on value.
- Be person-centered.
- Protect privacy and security in all aspects of interoperability and respect individual preferences.
- Build a culture of electronic access and use.
- Encourage innovation and competition.
- Build upon the existing health IT structure.
- One size does not fit all.
- Simplify.
- Maintain modularity.
- Consider the current environment and support multiple levels of advancement.
The roadmap also addresses the main stakeholders of interoperability, as there are many involved in affecting patient care outcomes. These stakeholders include:
- People receiving care or supporting others’ care
- People/organizations delivering care and services
- Organizations paying for care
- Governments supporting the public good
- People/organizations generating knowledge through research and/or quality improvement
- People/organizations providing health IT capabilities
- People/organizations with oversight
- People/organizations developing and/or maintaining standards
Obstacles to Achieving Interoperability
According to EHR Intelligence, there are some challenges that need to be overcome before reaching true interoperability.
Creating a standard way of patient identification: The ONC hosted a Patient Matching Algorithm Challenge in June 2017 to advance this issue. The winner, Vynca, used a stacked model combining eight different model predictions.
“Patient matching is almost universally needed to enable the interoperability of health data for all kinds of purposes,” wrote ONC Director of Standards and Technology Steve Posnack, MS. “While numerous recommendations have been issued over the years to tackle different aspects of patient matching, it is important to recognize that the entire healthcare system can impact its performance.”
Enforcing health IT standards across facilities: Organizations can see interoperability standards differently, meaning not all operate with the same levels. Thus, it can make data transfers difficult and creates another roadblock to information moving from place to place. Companies have worked to create initiatives that not only facilitate data exchange, but also work with an organization’s current EHR system to promote these standards.
As these companies grow, they could help address the lack of standardization in healthcare organizations, according to EHR Intelligence.
Working with industry stakeholders: As the ONC roadmap pointed out, there are many stakeholders in the interoperability process. The organization planned out three multi-stakeholder meetings to create a nationwide plan to standardize this. By working with stakeholders, the ONC wants to make sure there are consistent interoperability policies industry-wide and work to remove blocks to the interoperability process.
Continuing advancements will help to move along the drive toward true interoperability, and some of the key stakeholders in the process will be healthcare management as they work to steer their organizations toward a future seamless, streamlined process.
