Interoperability in healthcare is a vital lifeline that enhances patient care as data is shared across a variety of medical environments and care settings. It’s often thought of as simply a branch of health information technology, but it’s more than that; it involves the integration of various information systems.
The seamless exchange of information and healthcare data facilitated by interoperable electronic health records (EHR) systems is transforming the way healthcare providers communicate and collaborate. With the smooth flow of critical data between health information technology and the providers using them, interoperability ensures every member of a patient’s care team, regardless of location, has access to the same timely, accurate, and comprehensive health data.
This connectivity is critical in healthcare interoperability, where a patient might see multiple specialists and undergo various treatments and tests, both to treat acute conditions and manage chronic conditions. Healthcare interoperability ensures clinical data captured by health IT—meaning every test result, diagnosis, and treatment plan—is readily available. This not only accelerates medical decision-making but can also significantly reduce the risk of errors and duplication of services.
Benefits of the Health Information Exchange
This health information exchange is incredibly helpful in acute care situations. For example, when an emergency physician or nursing team has instant access to a patient’s complete medical history, they can provide more personalized and effective care and avoid unnecessary and impactful delays.
Moreover, interoperable EHR systems can empower patients by making their medical records more accessible—from securely messaging providers and scheduling appointments to managing chronic conditions—fostering a more transparent approach to healthcare management. Equipped with tools to manage their wellness proactively, patients become more active participants in their own care.
As healthcare technology continues to evolve and the industry moves more towards value-based care, the importance of building robust interoperable systems cannot be overstated. It’s more than simply a means for more efficient administrative workflows; health data interoperability is a foundation for a more collaborative, effective, patient-centered healthcare ecosystem.
The 4 Levels of Health Data Interoperability
Before delving into the top benefits of interoperability in healthcare, it’s important to define the wider scope of healthcare interoperability from the health data experts.
Members of the Healthcare Information and Management Systems Society (HIMSS) consider health data interoperability to be “the ability of different information systems, devices, and applications (systems) to access, exchange data, integrate, and cooperatively use data in a coordinated manner, within and across organizational, regional, and national boundaries, to provide timely and seamless portability of information and optimize the health of individuals and populations globally.”
Healthcare interoperability is commonly discussed in terms of four different levels, each representing a progressively more integrated and functional exchange of information.
Foundational Interoperability
Foundational interoperability is the most basic level of healthcare interoperability, allowing systems to exchange data without requiring the ability to interpret it. It allows one system to send and receive data to and from another but does not require the ability to interpret the data. This level ensures that data exchanged via IT systems is received and can be displayed by the recipient system.
Foundational healthcare interoperability focuses mainly on establishing the connectivity necessary for data exchange, without concerning itself with the ability for the systems to actually “understand” or process the data in any meaningful way. Examples of this level of interoperability include:
- Direct secure messaging, a standardized protocol used in healthcare to send health information securely between healthcare entities.
- Health information service providers (HISPs), which facilitate the exchange of health information across different networks.
- Electronic Health Records (EHR) system data export and import functions.
- Interface engines, which act as intermediaries that facilitate the transfer of data between disparate healthcare systems.
- Virtual private networks (VPNs) and other similar network technologies provide secure channels for transmitting healthcare data between entities.
Structural Interoperability
Structural interoperability takes things a step further by ensuring that data exchanges between health information systems can be interpreted at the data field level.
This level of healthcare interoperability is concerned with the structure or format of data exchange, where the format of the data exchange is uniform across systems, thus ensuring that the data can be correctly parsed and understood structurally. It involves the use of data formats and standards (like HL7 and XML formats) that maintain the integrity of data when it is exchanged between different computer systems.
Examples that illustrate structural interoperability in healthcare include:
- Standardized data formats (i.e., Health Level 7) that serve as sets of international standards for the exchange, integration, and retrieval of electronic health information.
- Continuity of Care Document (CCD), a standard for the exchange of patient summary information among healthcare providers.
- Fast Healthcare Interoperability Resources (FHIR), a standard describing resources (i.e., data formats and elements) and an application programming interface (API) for the exchange of EHRs.
- Digital Imaging and Communications in Medicine (DICOM), a standard for storing, printing, and transmitting information in medical imaging.
- Integrating the Healthcare Enterprise (IHE) profiles, which provides a common framework for achieving interoperability between healthcare software applications.
Semantic Interoperability
Semantic interoperability allows for the meaningful use of exchanged data, where both systems can interpret, understand, and utilize the health information being shared. At this level, data is not only exchanged between digital health systems but also interpreted in the same way by different systems.
Semantic healthcare data interoperability is achieved using common data models, vocabularies, and ontologies that are universally understood, ensuring that clinical or operational information communicated between systems is clear and actionable. Examples of semantic healthcare interoperability in action include:
- International Classification of Diseases, 10th Revision (ICD-10), a standardized code for diseases, symptoms, and procedures across different healthcare systems.
- Systemized Nomenclature of Medicine – Clinical Terms (SNOMED CT), a comprehensive, multilingual clinical healthcare terminology set.
- Clinical Decision Support Systems (CDSS), which leverage semantic interoperability to provide clinicians with intelligent insights and information.
- Interoperable Healthcare Protocols like HL7 Fast Healthcare Interoperability Resources (FHIR with Semantic Extensions), which ensure data can be effectively interpreted and used across multiple health information technology systems across provider and payer organizations.
Organizational Interoperability
Organizational interoperability is the capability of different organizations and health systems within the healthcare ecosystem to effectively communicate, collaborate, and deliver care that is patient-centric and aligns with broader health policy requirements.
This level of healthcare interoperability addresses the policies, social context, and regulations governing data sharing and aims to improve the delivery of healthcare services at a systemic level. This includes aligning the goals, processes, and workflows of various healthcare organizations to facilitate coordinated and efficient healthcare delivery.
Examples of organizational healthcare interoperability in use include:
- Accountable Care Organizations (ACOs), or groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients.
- Integrated Delivery Networks (IDNs), a network of facilities and providers that offer a continuum of care to a specific geographic area or patient population under a unified administrative framework.
- Health Information Exchanges (HIEs), which facilitate the digital mobilization of health information across organizations within a region, community, or hospital system.
- Public health reporting initiatives, which require data sharing between healthcare providers and public entities.
Health data interoperability is essentially about making different healthcare systems, devices, and applications work together smoothly. When these technologies can access and share data easily, they can use that information to help healthcare providers deliver better and more efficient care.
This cooperation between systems is not just important within a single hospital or clinic, but also across different healthcare organizations and even across countries. The main goal of healthcare interoperability is to make sure that wherever patients go, their health information can travel with them quickly and safely, helping doctors make the best decisions for their care, and ultimately improving health outcomes for everyone, everywhere.
Top 5 Benefits of Healthcare Interoperability
Exchange data and seamless exchange of electronic health information can bring a number of benefits to the entire healthcare ecosystem, significantly improving patient care, efficiency, and health system sustainability. When considering these benefits, the following five rise to the top of importance, especially as the healthcare industry evolves toward value-based care models.
1. Improved Patient Outcomes
Enhanced interoperability, including improved EHR interoperability, is critical in facilitating real-time, comprehensive access to patient health records across different systems. The result is improved patient outcomes. This means that healthcare providers have immediate access to vital information, such as allergies, current medications, past medical history, and recent test results, regardless of where the patient received care previously.
Such access helps in making informed clinical decisions, reduces errors, and allows for more personalized and effective treatment plans, ultimately leading to better patient outcomes.
2. Increased Efficiency and Reduced Costs
Interoperability helps eliminate redundant procedures and tests by enabling systems to exchange data, saving time and reducing healthcare costs. By sharing patient healthcare data among providers, the need for repeating laboratory tests or imaging studies that have already been performed elsewhere is minimized.
This not only speeds up the diagnosis and treatment processes but also reduces the financial burden on patients and the overall healthcare system.
3. Enhanced Care Coordination
With interoperable systems, the coordination between different specialists, primary care providers, and healthcare facilities is significantly improved. For patients with complex or chronic conditions—people who often see multiple healthcare providers—interoperability ensures that all involved parties are up to date with the patient’s condition and treatment plan, helping to promote patient safety and success.
This coordinated approach helps in delivering a unified strategy for patient care, which is especially important during transitions between care settings.
4. Patient Empowerment and Engagement
Interoperability enhances patient engagement by providing patients with easier access to their own medical records and healthcare professionals through systems that can exchange data, such as patient portals and mobile apps.
This access enables patients to actively participate in healthcare decisions, manage their treatments more effectively, and communicate better with their healthcare providers. Empowered patients are typically more compliant with treatment plans, which can lead to improved health outcomes.
5. Public Health and Research Advancements
Interoperability significantly contributes to public health monitoring and research by facilitating the collection and analysis of large sets of patient health data across various health information systems. This capability allows for more effective tracking of disease outbreaks, faster responses to public health emergencies, and better-informed health policy decisions.
Additionally, more seamless data sharing can be used for medical research, improving the understanding of diseases and leading to innovations in treatment and prevention methods.
Greatest Challenges in Achieving Interoperability in Healthcare
Interoperability in the U.S. healthcare system faces several significant challenges that impact the effective exchange data and use of information across different health IT systems, including EHRs. These challenges span technical, regulatory, and practical domains.
Data Standardization
One of the biggest technical challenges relates to EHR interoperability and involves the lack of standardization across different systems. Various providers use systems that record, store, and transmit data in incompatible formats. Establishing common data standards is crucial for ensuring that information can be shared seamlessly and interpreted correctly by different systems.
Privacy and Security Concerns
Protecting patient privacy and ensuring data security is paramount, especially when systems exchange data across various networks. Interoperable systems increase the risk of data breaches as they often require data to be transmitted across various networks. Complying with HIPAA standards and other regulations while maintaining interoperability poses significant challenges.
Cost and Complexity of Implementation
Integrating health information systems can be expensive and complex. Healthcare providers, especially smaller practices or hospitals, may find the cost of upgrading systems prohibitive. The complexity of implementing these systems (or switching from other systems) without disrupting existing workflows can also be a significant barrier that holds some facilities back.
Regulatory and Policy Limitations
While there have been legislative efforts to improve interoperability and exchange data (like the 21st Century Cures Act passed in 2016 to help accelerate healthcare product development and innovation), regulatory progress is often slow and can be outpaced by technological advancements. Ensuring that laws and regulations facilitate rather than hinder interoperability is an ongoing challenge.
Patient Data Matching
Patient matching, or the accurate identification and linking of patient healthcare data across health information systems, is critical for effective interoperability. Errors in data matching can lead to incorrect patient information being shared or used in treatment decisions, posing risks to patient safety.
Resistance to Change
Implementing interoperable healthcare IT systems requires significant changes in how healthcare providers operate and manage patient data, including how they exchange healthcare data. Resistance to change among staff and the training required to use new systems effectively are considerable challenges and can lead to issues with patient care as well.
Fragmentation Across Healthcare Settings
The U.S. healthcare system is highly fragmented, with various types of care settings (acute, ambulatory, post-acute, home care, etc.) often using different health information systems that are not designed to work together. Bridging these gaps is essential for a truly interoperable healthcare environment.
Addressing these challenges requires coordinated efforts among healthcare providers, tech solutions vendors, policymakers, and other stakeholders in the healthcare industry. Continued technological advancements, along with more supportive policies and standards, are essential in overcoming these hurdles and achieving a fully interoperable healthcare system in the U.S.
Considering EHR Interoperability When Choosing the Best Data Solution
When selecting an Electronic Health Record system, EHR interoperability is a vital factor to consider. Selecting a highly interoperable EHR helps ensure seamless healthcare data exchange, optimal functionality, and broad utility across the healthcare spectrum.
Here are the key aspects of technical interoperability to evaluate when considering EHR solutions for your healthcare operation.
Compliance with Standards
Ensure the EHR system adheres to established healthcare information standards such as HL7, FHIR, and ICD-10. Compliance with these standards guarantees the system can communicate effectively with other systems, facilitating accurate and efficient data sharing.
Healthcare Data Sharing Capabilities
Evaluate how well the EHR can exchange healthcare data with other systems, including other EHRs and other peripheral systems related to your field (i.e. laboratory information systems [LIS], radiology information systems [RIS], pharmacy systems, etc.). This includes not only sending and receiving healthcare data but also ensuring the information can be integrated into workflows smoothly and used effectively by healthcare providers.
Scalability and Flexibility
Technical interoperability should consider whether the EHR system can scale and adapt to the evolving needs of your healthcare practice. It should be flexible enough to integrate with future technologies and expand as new healthcare facilities, services, or partners are added.
User Interface and Usability
The user interface of EHR systems should facilitate rather than hinder interoperability. This includes clear displays of integrated data from multiple sources and intuitive navigation that helps rather than hinders the understanding and use of shared data.
Patient Data Access
Be sure different EHR systems being considered by your team support patient access to their own healthcare data through patient portals or other means. This aspect of EHR interoperability enhances patient engagement and satisfaction by making it easier for patients to access their records and manage their health, improving patient care and benefitting the healthcare industry as a whole.
Security and Privacy
Assess the security features of EHR systems to ensure they can protect patient data during exchanges between different systems. Compliance with HIPAA and other relevant privacy regulations is vital in protecting patient information and avoiding legal issues.
Vendor Support and Community
Always consider the level of support provided by the vendor for EHR interoperability issues, including updates and troubleshooting. Additionally, consider the size of the vendor’s user community as larger communities often have more developed ecosystems, often providing more resources and better opportunities for interoperable solutions.
Performance Metrics and Reporting
EHR software should be able to compile data from various sources into coherent reports, supporting performance tracking and decision-making. This requires effective interoperability to ensure that all data inputs are accurately captured and reflected in reporting outputs.
By carefully evaluating these aspects, healthcare providers can choose an EHR system that not only meets their immediate needs but also supports comprehensive interoperability for more efficient and effective healthcare delivery in the long run.
The Future of Interoperability in Healthcare
The future of healthcare interoperability holds the potential to transform how care is delivered, experienced, and managed, especially as systems continue to exchange data more effectively. As technology advances and policy frameworks evolve, we can expect even more robust interoperability solutions that not only streamline operations but also significantly enhance patient outcomes.
Innovations such as the expansion of artificial intelligence (AI) and machine learning within healthcare systems are set to further refine data analytics, predictive modeling, and real-time decision support, all integrated through interoperable platforms. These advancements will facilitate more personalized and preemptive healthcare approaches, moving us closer to truly patient-centered care.
Moreover, policy developments play a critical role in this evolution. Legislative measures like the 21st Century Cures Act have already laid the groundwork by mandating open data exchange and prohibiting information blocking. Future policies must continue to encourage the development of standards and frameworks that support seamless data integration across diverse healthcare ecosystems.
Encouraging the adoption of best practices through incentives for compliance and penalties for non-compliance (such as those already in place with several value-based care payment programs) could drive widespread changes across the industry.
Ultimately, as interoperability grows, so does the entire healthcare landscape’s ability to respond more dynamically to patient needs and public health challenges. By continuing to invest in and prioritize interoperability, the healthcare sector can unlock new efficiencies, improve care quality, and enhance patient satisfaction, carrying all of us into a new era of connected health.
