It’s the reason why patients can send healthcare data from their Bluetooth-enabled blood pressure cuff to their provider’s electronic health record (EHR). It’s how an emergency room (ER) physician can access test results from a patient’s cardiologist with the click of a button. Or why a primary care physician can directly send electronic care summaries to a gastroenterologist when referring patients. It’s also a driving force behind a payer's or health system's risk management and compliance strategy.
We’re talking about healthcare interoperability—the ability of different information systems, devices, and applications to access, exchange, integrate, and cooperatively use healthcare data in a coordinated way. The goal? To provide timely and seamless access to information that can optimize health outcomes and improve patient care. There are countless examples of interoperability in healthcare, all of which are completely behind the scenes, helping providers and payers render high-quality patient care every minute of every day.
The Office of the National Coordinator’s (ONC) goal is to achieve nationwide healthcare interoperability by 2024. That means in just three short years, the U.S. is aiming to have a patient-centric system that can continuously improve care, public health, and science through real-time data access.
The most recent step toward healthcare interoperability is the passage of CMS’ Interoperability and Patient Access Final Rule that promotes seamless healthcare data exchange, enables better patient access to their medical records, and improves interoperability. This rule is an important step toward achieving true healthcare interoperability nationwide.
What is healthcare interoperability?
Think of interoperability as a universal language that disparate systems (e.g., mobile apps, third-party systems, electronic health records, and more) use to communicate. They do this by using healthcare data exchange architectures, application program interfaces, and standards. Without healthcare interoperability, healthcare providers and others wouldn’t have critical information at their fingertips and data would remain siloed. Just as two people who speak different languages couldn't communicate without the help of a translator, multiple systems could not engage in data sharing without a common language.
What data is exchanged via interoperable systems?
Health information technology systems that adhere to the United States Core Data for Interoperability (USCDI v1) standards are able to exchange a variety of information, including demographic information, vital signs, smoking status, medications, lab results, clinical notes, allergies and intolerances, and much more. The list is growing as standards for data sharing emerge.
What are the standards for hospital interoperability?
There are five types of standards associated with healthcare interoperability:
- Vocabulary/terminology standards
- Content standards
- Transport standards
- Privacy and security standards
- Identifier standards
Standards provide a common language and a common set of expectations that support data exchange between systems and/or devices.
Why is interoperability important in healthcare?
Interoperability is important in healthcare because patients receive care from multiple providers working in multiple healthcare systems and may be on multiple payer panels. The need for seamless patient data flow is paramount. Consider a physician in the ER treating a patient for a heart attack. Without healthcare interoperability with the local pharmacy, the ER physician wouldn’t be able to immediately access the patient’s medication list. Instead, they would need to ask the patient to recall every medication and dosage. This may not even be possible if the patient isn’t conscious. Even if the patient is conscious, he or she may not be able to provide accurate information. All of this impacts care delivery and the physician’s ability to provide the most effective and efficient care.
Here’s another example of why healthcare interoperability matters: Home-based care for patients with chronic diseases was crucial during the COVID-19 pandemic. Thanks to interoperable medical devices, many patients were able to capture certain physiological parameters (e.g., temperature, blood pressure, weight, and respiratory rate) and wirelessly transmit that healthcare data to their medical record where providers could access and monitor it. These are patients who might have otherwise fallen through the cracks during a time when stay-at-home orders were common. Many of these patients have continued to engage in remote patient monitoring throughout the pandemic because of its convenience. In addition, provider and payer organizations benefit when patients stay healthy.
What are the interoperability levels?
When it comes to healthcare interoperability, not all levels are created equally. Consider the following:
Foundational
This level establishes the basic standards necessary for one system or application to securely communicate with another. With foundational healthcare interoperability, data information technology solutions can’t interpret the healthcare data they receive. To process the data and extract meaningful information, additional levels of interoperability are needed.
Structural
This level defines the format, syntax, and organization of data sharing. Health Level 7, for example, provides guidance on how messages should be structured. HL7’s Fast Healthcare Interoperability Resources, which defines about 140 common healthcare concepts, is an emerging standard for communicating healthcare data. With structural healthcare interoperability, data information technology solutions can interpret the healthcare data they receive. However, the content of a structured message may not be standardized, which means higher levels of understanding between systems may not be possible.
Semantic
This level of healthcare interoperability includes medical terminologies, nomenclatures, and ontologies. It ensures that medical concepts can be shared across systems. With semantic interoperability, data information technology solutions can exchange, interpret, and use the healthcare data. For example, with more than 340,000 medical concepts, the terminology SNOMED is a general-purpose language for advancing semantic interoperability in medicine and healthcare. Domain-specific terminologies include Logical Observation Identifiers Names and Codes (LOINC) for laboratory observations, the Identification of Medicinal Products (IDMP) for medicines, the nomenclature of the HUGO Gene Nomenclature Committee (HGNC) for genes, or the Human Phenotype Ontology (HPO) for phenotypic abnormalities.
Organizational
This level includes governance, policy, social, legal, and organizational considerations for healthcare interoperability—all with the overarching goal of facilitating secure, seamless, and timely healthcare data exchange between organizations, entities, and individuals. This is the level of interoperability toward which all healthcare entities are ultimately moving. It requires common business processes and workflows that enable the seamless provision of healthcare across institutions.
What is health information exchange and data sharing?
As a verb, health information exchange (HIE) refers to the electronic transfer of clinical information between disparate healthcare information systems while maintaining the meaning of that information. The goal? Facilitate access to and retrieval of clinical data to provide safe, timely, efficient, effective, and equitable patient-centered care. Without healthcare interoperability, HIE and data sharing wouldn’t be possible.
However, HIE is also a noun, referring to organizations within the U.S. that provide HIE technology and services at a state, regional, or national level. HIEs often work directly with communities to promote secure sharing of health data. For example, during Hurricane Harvey in 2017, Greater Houston Healthconnect, a regional HIE, assisted doctors treating evacuees in area shelters. Its staff used the HIE’s portal to look up medication, diagnosis, allergy, and other critical healthcare data to treat current and emerging health issues. More recently, HIEs have supported public health agencies in their response to public health emergencies like COVID-19, serving as hubs for rich healthcare data from a multitude of sources.
What are benefits of healthcare interoperability?
Healthcare interoperability has many benefits. For example, information exchanged between providers helps inform the visit and prevents the duplication of tests. Think of an ER physician who can access a recent blood test result from a specialist so he or she can make a timely decision regarding the course of care without having to repeat the test. In this example, interoperability can actually reduce healthcare costs.
It also reduces the redundant collection of information from the patient. Think of a scenario where a hospital can pull insurance information from the patient’s medical record at a physician’s office. This prevents the patient from having to retrieve this information and provide it again. It also reduces the time it takes patients to brief their healthcare providers on their medical history, allowing more time for clinical discussions about health concerns. The outcome? Better patient care.
Healthcare interoperability is all about efficiency. For example, healthcare interoperability software enables automatic appointment reminders or follow-up instructions to be sent directly to patients. It allows physicians to send prescriptions directly to pharmacies. By saving time across the entire continuum of healthcare delivery, interoperability indirectly reduces costs and improves health outcomes throughout the healthcare industry.
What about preventing medication errors or other types of costly mistakes? Once again, healthcare interoperability can help. Think of a specialist prescribing a medication that interacts with the patient’s blood pressure medication. Interoperability alerts the specialist of this interaction so they can prescribe a different, safer medication. It also enables a whole host of additional clinical decision support tools for more effective patient care and treatment.
Healthcare interoperability can also stimulate consumer education and patient involvement in their own healthcare. Think of the primary care physician who can push educational materials through the patient portal to a patient recently diagnosed with diabetes. Without interoperability between the educational system and the electronic health record, this task would be manual and time- and resource-consuming.
When it comes to research, healthcare interoperability is key. Think of large-scale observational studies in the healthcare industry. Using interoperable formats for real-world data (e.g., data collected in medical care or even via mobile apps) opens up countless opportunities for researchers.
Finally, it improves digital medicine by facilitating big data analysis. Without healthcare interoperability, artificial intelligence algorithms wouldn’t have enough healthcare data to process. Processing information from different systems and across institutional boundaries is critical. In addition, these algorithms need accurate, standardized healthcare data. Running algorithms on unstructured, non-standardized healthcare data can introduce errors and compromise analysis results. The overarching goal is to create trust in digital technologies. Without interoperability, trust can be easily eroded.
How can healthcare interoperability enhance your compliance strategy?
Healthcare interoperability can greatly enhance a healthcare organization’s risk management strategy because it enables a high-level, big-picture view of compliance. When healthcare data from disparate systems feeds into a single analytics platform, for example, healthcare organizations can spot billing errors and suspected fraud in real time. When using compliance software with integrated healthcare provider directories, organizations can enhance enterprise healthcare provider data management. Interoperability makes this type of integration possible. Healthcare interoperability also makes it possible for compliance, quality, and safety software to enable quality monitoring and safety and incident reporting as well as vendor background checks, credentialing, training, and policy reviews. Interoperability is the foundation of all of these efforts.
As the healthcare industry forges ahead with interoperability and data sharing, the opportunities for healthcare organizations are endless. Healthcare interoperability enables lower costs, improved outcomes, and a more robust compliance strategy.
