In the healthcare context, interoperability describes the capability
of multiple software systems and applications that exchange data to
use the information within their systems cooperatively and to share
the information with other systems without special effort on the
user's part. Sometimes, interoperability is measured by the degree to
which the configuration of two or more systems supports the efficient
and effective data exchange across the systems. This is called
horizontal interoperability when the data flows across provider roles
or locations within the healthcare system (for example, a system for
referring patients between hospitals and individual practices or
across states, regions, or countries) and vertical interoperability
when the data is shared across a vertical sequence of care or
treatment services. To perform its function for clinicians and
patients, the system incorporating data for a single patient must be
able to pull data from relevant sources in the other information
systems. The healthcare provider treating a patient at a visit needs
relevant information from other systems describing the patient’s
history to make the most informed and cost-effective decisions
regarding treatment.
Yes, interoperability matters in the field of healthcare. Think of the
opposite of interoperability: healthcare organizations have large
silos of patient information with highly schematized interfaces. Now
imagine sending your dependent parent from primary care through a
series of doctor offices for evaluations: test results, diagnoses,
comments, and questions get transmitted inter-company from one office
to the next – but have to pass through hard paper in order to be
understood. That certainly doesn’t sound efficient. Rather,
interoperable systems encourage smooth continuity of care, enabling
authorized users to see all the relevant information about a patient
every step of the way. This reduces decision latency, helps avoid
duplicated tests and procedures, and improves patient outcomes.
Interoperability also promotes the development and adoption of novel
medical technologies and data analytics as the field works towards
providing higher-quality care in a more efficient way.
We will delve into the meaning of interoperability in healthcare
software systems and what it means for the healthcare sector when
software systems can communicate easily with each other. We will
answer some questions regarding the impact of interoperability on
patient care, including why interoperability is important, what the
beneficial aspects of interoperability are, and what the main
challenges organizations face in attaining interoperability are. We
will also share some best practices for overcoming these challenges.
They relate to a subject matter that is fundamentally of enormous
interest to healthcare providers and other stakeholders – in other
words, to all of us.
Health IT must facilitate the treatment, exchange, and use of clinical information between and among two or more IT systems within and across organizations. Interoperability can mean that IT systems and applications simply interact with one another. Such technical interoperability involves the ability to share data among systems using compatible technologies and protocols so that systems from different vendors or even with different technical architectures interact without a hitch. Beyond simple interaction, interoperability as we use it requires meaningful health IT applications. Semantic interoperability involves, for example, the sharing of data among systems in a format that is immediately recognizable and interpreted meaningfully in each system. It also implies that data elements are consistent in terms of meaning and formats across IT systems, allowing for the use of ‘built-in’ RFEs ( requests for equivalence) in those data meanings and formats.
The language of interoperability is fairly recent – initially, it focused on bits and bytes, which is the lowest common denominator of data exchange. However, as technology advanced and got smarter and more complex, the need grew for more sophisticated and formalized methods, such as the exchange of clinical lab results in a standard and consistent way to move decisions and data around the enterprise. There were key steps along the way in multiple domains of interoperability, such as the earliest exchange standards laid out in HL7 (Health Level Seven) standards, which defined how to exchange clinical and administrative data, and then advanced with FHIR (Fast Healthcare Interoperability Resources), which takes web technology and formats as the foundation.
Improving interoperability in healthcare greatly facilitates patient care because it means critical patient information can be shared between different systems and providers, enhancing care coordination. All other authorized practitioners or systems can access all information known to a practitioner or protected healthcare system. This level of information integration decreases the risk of medical errors from incomplete or erroneous data, reduces unnecessary duplication of tests and procedures, and allows care to be better tailored to each patient’s specific needs.
Operational efficiency also benefits from interoperability. Improved workflow efficiency and reduced administrative burden allow healthcare organizations to operate more efficiently. Data exchanges between applications can be automated, eliminating the need to manually enter data and reducing errors, allowing staff to spend more time with patients. Cost savings are also realised as redundant tests and procedures can be reduced and administrative resources are used more efficiently. This efficiency is passed on to lower healthcare costs, leading to greater financial sustainability.
Such interoperability makes it easier to aggregate data, a key factor for improved analytics and, therefore, decision-making. The resulting integrated perspective of all data from multiple sources across a healthcare organization, for example, provides insights into patterns among patient populations and outcomes from treatments, as well as providing efficiencies in service design and delivery. Any resulting trends or patterns can be captured for broader analyses that will inform strategic planning and tactics and lead to improved patient care and population health outcomes.
Technical barriers stem from legacy systems and interface compatibility complications. Healthcare providers across the spectrum still use antiquated technologies that may not be compatible with newer systems or standards, creating huge barriers to data exchange and integration. Another complexity is data standardization, which also proved to be a significant complication. Differing systems utilize different structured data fields, such as separate sets of codes for diagnoses or medications, making it hard to translate them into standard formats for uniformity across platforms. Integrating various systems is also time-consuming since the data formats used need to be synchronized and standardized to prevent inconsistencies in communication channels, an immense roadblock to interoperability.
There are also regulatory compliance issues that make achieving regulatory and cross-provider interoperability extremely challenging. Health information standards and healthcare regulations vary from region to region and system to system, and healthcare organizations must navigate differences in the requirements each jurisdiction sets in place. Depending on where you are, you could be operating under regulations such as the Health Insurance Portability and Accountability Act (HIPAA) in the US, the General Data Protection Regulation (GDPR) in Europe, or one of the many other laws or guidelines and standards on data standards, data exchange and privacy that influence the healthcare industry today. With regard to patient data, the nature of the data means that there are numerous security and privacy issues that arise in sharing this information between systems and providers. Ensuring that interoperability doesn’t break trust with patients about the safety and security of healthcare information is a huge, perhaps impossible, challenge of regulatory and cross-provider interoperability.
Organizational and cultural barriers also pose challenges to the quest for interoperability. Stakeholders simply don’t want to change. They might not see an incentive for change, and they might be scared of unknown outcomes – the risk of losing their jobs or access to lucrative contracts. There also might be a misalignment of organizational priorities and protocols between those who provide healthcare, those who make and sell software and hardware, politicians who make policy and oversee tax dollars, and patients. Each organization might have its own goals and processes – and what works in one location might not translate well to another. Effective change management strategies could help alleviate change resistance. A clear mission or vision of where integrated systems will get us all might provide common ground to move forward together.
Probably the most powerful way to improve interoperability is to take advantage of standardized protocols and frameworks such as HL7 (the Health Level Seven international standard), FHIR (an acronym for Fast Healthcare Interoperability Resources), and IHE (Integrating the Healthcare Enterprise). HL7 sets up rules and data formats that have become widely adopted by health IT systems. FHIR and IHE lay out more detailed protocols, rich data models, and extensive use cases. Following such standards ensures that health records can be exchanged between platforms and organisations that are willing and able to speak the same ‘language’. Such efforts supported by these protocols enhance technical interoperability, in which data exchanged is meaningfully understood when it reaches its destination.
Upgrading legacy systems to support current interoperability standards is essential, as legacy systems may be hard to modify for more recent interoperability standards. APIs (Application Programming Interfaces) and integration platforms are beneficial technologies that enable seneses. APIs allow applications developed by different software companies to talk to each other, to exchange data, and to share information. In theory, APIs enable data-sharing and data integration between systems in real-time, instantaneously, wherever needed, and whenever needed. In practice, integration platforms can orchestrate these data connections, simplifying the deployment of these solutions and their ongoing management in complex systems.
Increasing interoperability also means collaborating and communicating with other stakeholders. Developing relationships with healthcare providers, technology vendors, and regulatory agencies can help get people on the same page so that all of their respective needs and standards are met when implementing an interoperable system. Bringing all parties together fosters a sense of purpose, ensures all stakeholders are invested,, and serves as a catalyst for building bridges around the healthcare ecosystem. Collaborative efforts not only create a culture of shared objectives and joint goals within different organizations but may also provide valuable insights and opportunities to build stronger relationships. Tackling problems together, sharing best practices, and ultimately providing better healthcare outcomes can serve as catalysts for improving levels of communication within and across healthcare entities.
By increasing the ability of these software systems to communicate and share information across various entities, interoperability can address some of healthcare’s most pressing needs and challenges, including the fragmentation of data and the inefficiencies that follow. The benefits of interoperability – including improved patient outcomes, administration, workflow, and costs – will provide a vital foundation for delivering care to patients and providers. Along with the benefits of interoperability for patients and healthcare providers, the creation of a unified healthcare system will also spur more innovation in health technology. Although healthcare software is not a new concept, understanding its value for patient care and efficiency is essential. However, the challenges to achieving this level of communication and automatic data exchange within and between hospitals, clinics, and other departments are complex and necessitate the adoption of best practices by all parties involved.