Interoperability in healthcare is vital to streamlining services, preventing medical mistakes, and improving communications.
The sudden onset of Covid-19 has put the need for greater interoperability at the forefront.
The U.S. Department of Health and Human Services (HHS) plays a crucial role in promoting interoperability in healthcare through legislation and initiatives aimed at improving the exchange of patient data and supporting the integration of various healthcare systems.
But several barriers still exist. Recognizing these barriers and finding real solutions reduces their impact and facilitates the process towards true foundational interoperability.
What is Interoperability in Healthcare?
Interoperability in healthcare refers to the ability of different healthcare information systems, devices, and applications to access, exchange, integrate, and cooperatively use data in a coordinated manner. This capability is crucial for healthcare providers as it allows them to share patient data, medical histories, and other relevant information across various healthcare settings. By doing so, it ensures that patients receive consistent and high-quality care regardless of where they are treated. The Healthcare Information and Management Systems Society (HIMSS) defines interoperability as the ability to provide timely and seamless portability of information, optimizing the health of individuals and populations globally. This definition underscores the importance of interoperability in enhancing patient outcomes and streamlining healthcare processes.
The Four Levels of Interoperability
Interoperability has multiple levels corresponding to the number of devices or programs integrated into the system. The Healthcare Information and Management Systems Society, Inc. (HIMSS) has outlined three levels of basic interoperability and added a fourth in March 2019 to accommodate the needs of larger institutions, emphasizing the critical role of health information technology in achieving organizational interoperability within the healthcare sector.
Level One – Foundational Interoperability
This level creates the most basic form of interoperability. While most facilities will start at this stage, few will remain here aside from the smallest practices. Foundational interoperability only requires safe, secure, and reliable connectivity between a pair of systems. While the systems can exchange information and receive data, ensuring consistent formats and standardized protocols is crucial for effective data interpretation. According to one study from 2019, 26% of facilities reported only having a foundational level of connectivity.
Level Two – Structural Interoperability
The second level is structural interoperability. This level differs from the first in the ability for the sharing systems to interpret received data as information fields. The syntax for translating the data is a hallmark of this step. Structural interoperability was the most popular of the first three levels, with 38% of study respondents reporting this stage in their facilities.
Level Three – Semantic Interoperability
This is the ideal level for many small and medium-sized healthcare facilities. Information passes easily between systems and each system can completely interpret that information. Patient data passes easily through channels without the need for third parties. Additionally, all data shared electronically in this and in all other levels of interoperability only permits authorized users access to ensure HIPAA compliance. Before having a chance to integrate organizational interoperability, semantic was the second-most popular of the first three levels with 36% of healthcare facilities surveyed using it.
Level Four – Organizational Interoperability
The most recent addition to the list is organizational interoperability. This level integrates technology and personnel infrastructures within a health system to facilitate the process of quickly, easily, and securely sharing information among authorized people, entities, organizations, and healthcare facilities. Different components of a health system, such as back office operations and front-line clinical services, interact with electronic health records and health information technologies to improve patient care and data exchange. Large healthcare facilities with numerous staff will need to consider how to govern the changes, which policies to implement, how to train workers, and the legal implications of interoperability and data exchange.
Benefits of Interoperability in Healthcare
Interoperability in healthcare offers numerous benefits that significantly enhance the quality and efficiency of care delivery:
Improved Patient Care: By enabling healthcare providers to access comprehensive patient data, interoperability leads to better-informed decision-making and more effective treatment plans. This holistic view of patient information ensures that care is tailored to individual needs.
Enhanced Patient Safety: Sharing patient data across systems reduces the risk of medical errors, improves medication management, and helps prevent adverse events. This is particularly important in emergency situations where timely access to accurate information can be life-saving.
Increased Efficiency: Interoperability streamlines clinical workflows and reduces administrative burdens, allowing healthcare providers to focus more on patient care rather than paperwork. This efficiency translates to faster service delivery and improved patient satisfaction.
Better Population Health Management: By facilitating the sharing of health data, interoperability enables healthcare organizations to track population health trends, identify areas for improvement, and develop targeted interventions. This proactive approach helps in managing public health more effectively.
Reduced Healthcare Costs: Interoperability helps minimize duplicate tests, procedures, and administrative tasks, leading to significant cost savings. By eliminating redundancies and improving resource utilization, healthcare organizations can operate more sustainably.
Why Healthcare Systems Aren’t Interoperable for Patient Data
With so many benefits to fully interoperable systems in healthcare, most people wonder why we haven’t got there yet. In fact, several difficult hurdles still exist.
First, many facilities have taken a staggered approach to adopting new technology. The result is a variety of programs that don’t communicate with each other. Many EHR vendors pose serious challenges for healthcare facilities aiming to integrate. With the average healthcare facility using 18 different vendors for their EHR, communications between software become increasingly difficult.
While EHRs provide the backbone of patient care, hospitals and other healthcare facilities can also use dozens or hundreds of additional applications in their operation. And integrating these with the myriad of EHR programs is no small feat.
For IT professionals looking at creating an interoperable system from these disparate programs, the situation feels unworkable. Health data exchange architectures play a crucial role in enabling secure and efficient data sharing across various systems, organizations, and stakeholders.
Another issue stems from this, namely the amazing persistence of antiquated technology. Legacy hardware and software tend to not connect or be compatible with newer systems. A system still running Windows 95 simply doesn’t have the capabilities to properly submit secure data to another device using Windows 10.
Old computers running obsolete operating systems aren’t the only problem though. Retaining outdated and insecure devices and technology is another serious obstacle.
For instance, faxing still accounts for almost 75% of communications in healthcare. Facilities tend to use fax machines as a secure means of sending documents to other entities that don’t have compatible software. Medical offices use fax machines to submit claims and forms to insurance companies or to transfer referrals to other clinicians.
This use of fax gets around the lack of interoperability, but also poses more problems – potentially exposing patient data to unauthorized persons and wasting time sending, verifying receipt, and dealing with old and error-prone technology.
Interoperability may also be hindered by a lack of organization and/or miscommunication in a healthcare facility, something especially relevant to larger institutions. For instance, interoperability between departments becomes more difficult when each sector of a hospital has its own software and methods of record keeping. The lack of staff and resources necessary to organize and head the integration of interoperable systems in a facility needs addressing before making any significant upgrades.
While these barriers prevent the immediate creation of a fully interoperable system, they aren’t insurmountable. But failing to overcome these problems will leave the facility, staff, doctors, and patients vulnerable to all the inefficiencies and security risks posed by outdated technology and operations.
Strategies for Achieving Interoperability
Achieving interoperability in healthcare requires a multi-faceted approach that addresses both technical and organizational challenges. Here are some key strategies:
Adopting Standardized Data Exchange Protocols: Healthcare organizations should adopt standardized data exchange protocols, such as HL7 FHIR, to facilitate seamless data exchange. These protocols ensure that different systems can communicate effectively, reducing the risk of data silos.
Implementing Electronic Health Records (EHRs): EHRs are a critical component of interoperability, enabling healthcare providers to access and share patient data electronically. A well-implemented EHR system serves as the backbone of an interoperable health information exchange.
Developing Interoperable Health Information Exchange (HIE) Networks: HIE networks enable healthcare providers to share patient data across different healthcare settings, promoting seamless data exchange and care coordination. These networks are essential for ensuring that patient information is available wherever and whenever it is needed.
Promoting Semantic Interoperability: Semantic interoperability ensures that data exchanged between systems is understandable and usable, enabling healthcare providers to make informed decisions. This involves standardizing the meaning of data elements so that they are interpreted consistently across different systems.
Encouraging Collaboration and Data Sharing: Healthcare organizations should foster a culture of collaboration and data sharing among healthcare providers, payers, and patients. By promoting open communication and cooperation, organizations can overcome barriers to interoperability and improve patient care.
By adopting these strategies, healthcare organizations can achieve interoperability, improve patient care, and reduce healthcare costs. The journey towards interoperability is complex, but the benefits it brings to patient outcomes and operational efficiency make it a worthwhile investment.
Making Healthcare Interoperability a Priority
Too many facilities don’t prioritize technological upgrades necessary to provide the type of care they want to give. IT needs to push for making interoperability a priority. Until purchasing aligns with the goals of technology, interoperability will remain difficult.
The World Health Organization (WHO) is actively involved in fostering healthcare interoperability on a global scale, collaborating on projects like the Project Collaboration Agreement with HL7 to enhance the adoption of open interoperability standards worldwide.
However, with more standardization and adherence to IHE HL7 (including flexible software APIs), the process of building a data collection and sharing system that works throughout the facility and with others is more possible now than ever.
Through integrating interoperable systems, healthcare services become more cost-effective, more efficient, less wasteful, and more accurate. The choice to build such a system is no longer a “nice-to-have” option but an absolute requirement for any healthcare facility determined to provide the best possible care.