10 Key Aspects of Interoperability in Healthcare Everyone Should Know

• Kara L. Nadeau, Healthcare Industry Contributor

While healthcare delivery is dependent on the interconnectedness of people and processes within a health system or hospital - from those performing back office operations (e.g., supply chain, finance) to clinicians at the patient bedside - health information technology (IT) in these different areas has evolved separately and at different paces. Even within the clinical care function, different departments and specialties might use disparate healthcare information systems.

The modern digital health era and the necessity for seamless data exchange has driven healthcare organizations to pursue interoperability among their systems. The Healthcare Information and Management Systems Society (HIMSS) defines interoperability as:

"The ability of different information systems, devices and applications (systems) to access, exchange, 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."

Integrating IT systems to facilitate automated, electronic health data sharing as opposed to manually keying information into standalone solutions has a significant impact on lowering costs, improving care quality and enhancing financial outcomes for healthcare organizations.

Here are 10 key aspects of healthcare interoperability that stakeholders should take into consideration when bridging their health information technology gaps.

Table of contents

1. The four levels of healthcare interoperability
2. Interoperability and patient care
3. Supply chain management and interoperability
4. Hospital inventory management benefits
5. Bridging the gap with Health Information Exchange
6. Compliance and reporting for healthcare interoperability
7. APIs: Facilitating integration and interoperability
8. The problem posed by data silos
9. Cybersecurity, data and interoperability
10. Barriers to achieving interoperability

1. The four levels of interoperability in health care

HIMSS defines four levels of interoperability in healthcare to describe the different stages or degrees to which systems can exchange and use shared information. Achieving all four levels of interoperability is essential for creating a truly integrated and efficient healthcare ecosystem, where data flows smoothly and is always used meaningfully to enhance patient care and support supply chain operations.

1. Foundational Interoperability:

Foundational interoperability is the most basic level of interoperability. It allows one system to receive data from another, but not necessarily to interpret that data. Essentially, it ensures that data exchange can occur, but the receiving system might need further actions to make sense of the data.

For example, a hospital's enterprise resource planning (ERP) system shares data on products with its electronic health record (EHR) platform but the EHR user must search through this data to find the products they need to document in the patient's record.

2. Structural Interoperability

Structural interoperability ensures the data exchanged between systems maintains its structure and format (i.e., format, syntax and organization of the data). For instance, structural interoperability ensures that a lab result sent from one system to another will be received in an understandable, organized manner.

3. Semantic Interoperability

At the semantic interoperability level, systems can both exchange and interpret the information that is being shared by using the same terminology. This ensures that the precise meaning of the exchanged information is understandable by any other system across the continuum of care, making the data exchange meaningful.

4. Organizational Interoperability

Organizational interoperability encompasses governance and policy issues, among others, related to data exchange. This level of interoperability ensures that exchanged data can be integrated into care processes, business operations, and patient workflows seamlessly and that the stakeholders involved understand the value and purpose of this exchange. According to HIMSS, "these components enable shared consent, trust and integrated end-user processes and workflows."

2. Interoperability for patient-centered care

The patient care benefits of interoperability in healthcare can clearly be seen in the transition from manual to electronic health records. Industry-wide implementation of EHR solutions improves the accuracy and completeness of medical history documentation, enables efficient sharing of medical record data among healthcare providers and facilitates the patient's access to their personal health information.

Instead of a clinician spending their time with a patient keying their medical history into an IT system, they have immediate access to this information within the EHR, so they can focus their efforts not on record keeping but rather care delivery.

Having comprehensive and complete information on the patient's medical history at their fingertips, including diagnosed health conditions, prescribed medications, test results, past procedures and medical devices implanted in their bodies, clinicians can minimize the risk of medical errors and adverse events (e.g., harmful drug interactions) and enhance patient safety.

Electronic health records can also save time and money by preventing duplication of efforts, for example, a clinician running lab tests that were recently ordered/performed for that patient by another clinician.

3. Healthcare interoperability for supply chain management

Suppliers, distributors, group purchasing organizations (GPOs) and healthcare providers all have their own IT systems to manage supply chain processes, and historically they did not facilitate interoperable health information exchange. Each had their own core data related to a product and the activities around it (e.g., contracts, price, etc.). Lack of product data standards added to the complexity and challenges of healthcare interoperability and data sharing.

Even within healthcare organizations, different stakeholders have historically used different health information technology systems for supply management. While the supply chain team in a healthcare system typically relies on its ERP system to manage the product procure-to-pay (P2P) process, clinical departments might be using two or more systems to document item management and use - and in some cases, these systems do not exchange data with the ERP system.

This lack of healthcare interoperability in perioperative services, cath labs and other areas with consignment inventory (medical devices such as implants) has been a significant challenge because this category of inventory has historically been managed outside of the ERP system. With consignment product data sources in their own silos, supply chain lacks visibility to them and control over them, and clinicians bear the burden of their management and documentation.

In recent years, healthcare systems, suppliers and other stakeholders have made tremendous strides in improving healthcare interoperability in the supply chain, particularly when it comes to inventory management.

4. Hospital inventory management

Interoperable systems in the healthcare supply chain have had a tremendous impact on healthcare inventory management, enabling real-time tracking of medical equipment, pharmaceuticals, and other supplies. This aids in inventory management, demand forecasting, and ensuring timely availability of essential items.

Some health systems and hospitals are taking it one step further and consolidating their inventory management processes and data within a single inventory management platform that integrates with their existing systems (e.g., warehouse, ERP, EHR).

Use of a single supply chain management platform automates data capture and sharing among these systems–from the time an item arrives on the hospital dock through to point of use (POU) by a clinician on a patient–as opposed to hospital staff having to enter product data separately into each system.

This helps increase efficiency and reduce supply spend and waste by providing supply chain teams greater visibility and management of their supply assets.

5. Health Information Exchange (HIE): Bridging the Gap

HIMSS notes how the term "health information exchange" or "HIE" is generally used as either a verb or a noun:

• Verb: The electronic sharing of health-related data between two or more organizations facilitated by applied standards for use by a variety of stakeholders to inform health and care.

• Noun: Organizations within the United States that provide health information exchange technology and services at a state, regional or national level and often work directly with communities to promote secure sharing of health data.

According to the ONC, HIE is crucial to healthcare delivery as it "allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically—improving the speed, quality, safety and cost of patient care."

Health systems that share patient healthcare information are also better equipped to deliver equitable patient centered care as all parties have access to the same information. Here are the ONC's three key forms of health information exchange:

1. Directed Exchange: ability to send and receive secure information electronically between care providers to support coordinated care.

2. Query-based Exchange: ability for providers to find and/or request information on a patient from other providers, often used for unplanned care.

3. Consumer Mediated Exchange: ability for patients to aggregate and control the use of their health information among providers.

Picture a patient arriving in an emergency room (ER) for urgent treatment. Prior to interoperability in healthcare enabled by health information exchange, the triage nurse had to manually document the patient's health history before ER clinicians could proceed with diagnosis and treatment. Today, with the patient's data shared via HIE, the nurse can conduct a query for that patient's clinical data, review it, and direct care accordingly.

As with the use of electronic health records, appropriate, timely sharing of vital patient data can better inform decision making at the point of care and patient outcomes and allow providers to:

• Avoid readmissions
• Avoid medication errors
• Improve diagnoses
• Decrease duplicate testing

6. Regulatory Compliance and Reporting

Recognizing the patient care benefits that come from electronic health records and healthcare interoperability, the Centers for Medicare & Medicaid Services (CMS) and Office of the National Coordinator for Health Information Technology (ONC) have finalized rules to drive greater healthcare data sharing among providers and their patients.

The ONC Cures Act Final Rule and CMS Interoperability and Patient Access Final Rule "aim to eliminate barriers to health information interoperability and put individuals in control, shifting the industry from one in which you may share data in accordance with HIPAA, to one in which you must share data at the behest of the individual."

CMS requires eligible hospitals, critical access hospitals (CAHs), and clinicians to adopt, implement and upgrade various applications of certified EHR technologies to support healthcare interoperability, improve electronic reporting to public health, and ultimately improve patient care and efficiency across the healthcare and public health system.

There are increasing regulatory compliance requirements around interoperability in healthcare, including those related to patient access, privacy and security regulations.

For example, the Interoperability and Patient Access final rule (CMS-9115-F) "establishes policies that break down barriers in the nation’s health system to enable better patient access to their health information, improve interoperability and unleash innovation, while reducing burden on payers and providers." Just think about your own healthcare data and your ability to access it through your provider's patient portal.

7. APIs: The Silent Facilitators of Integration

Application Programming Interfaces (APIs) play a crucial role in healthcare interoperability. They facilitate the seamless flow of information between disparate systems, ensuring that both healthcare providers and patients have the information they need, when they need it.

ONC described APIs and their use in health data exchange architectures in this way: "Simply put, APIs allow a software 'Application A' to interact with a software 'Application B' without Application A needing to know how Application B’s software is designed internally."

The role of APIs goes beyond electronic health information and patient data sharing - they make medical records available, discoverable and understandable to the organizations and individuals accessing them (e.g., private providers, public health systems).

8. Data silos: The challenge to overcome

Data silos have a significant impact on healthcare interoperability. These isolated data systems can lead to a fragmented view of patient information or supply chain data, for example, which can hinder the overall efficiency and effectiveness of healthcare delivery.

As healthcare interoperability expands and organizations implement advanced digital technologies to analyze healthcare data (e.g., AL, ML), they need data that is not only accessible but also structured and standardized. It becomes less a matter of exchanging electronic health information among systems but rather enabling the systems to understand, process and use the data.

That's where interoperability standards come into play. Standards enable data sharing that is efficient and meaningful to the users.

The United States Core Data for Interoperability (USCDI), adopted as a standard in the ONC Cures Act Final Rule, "is a standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange. It is used not only to standardize healthcare data, but also "to align interoperability requirements and national priorities for health IT and health care broadly across industry initiatives."

The Health Level 7® (HL7) Fast Healthcare Interoperability Resources (FHIR) Specification "is the foundational standard to support data exchange via secure application programming interfaces (APIs)," according to CMS. The eCQI Resource Center describes the value of the FHIR Specification to healthcare interoperability:

"Electronic health records (EHRs) represent patient data in different ways (e.g., medications, encounters) and FHIR provides a means for representing and sharing information among clinicians and organizations in a standard way regardless of the ways local EHRs represent or store the data."

As HIMSS stated, "Data exchange schema and standards should permit data to be shared across clinicians, lab, hospital, pharmacy, and patient regardless of the application or application vendor."

9. Patient Data and Cybersecurity

Healthcare interoperability, while bringing numerous benefits in terms of data sharing and coordinated patient care, also introduces several cybersecurity risks. The integration and sharing of data among disparate systems can make healthcare data more vulnerable if not managed correctly. Interoperable medical devices and remote patient monitoring technologies add to the complexities and dangers.

The percentage of individuals impacted by healthcare hacks increased 68% in the past year, from 44 million impacted in 2022 to 74 million in 2023 (as of October 6, 2023). This is a 174% increase from the 27 million impacted in 2020.

Although there is no single solution to protecting patient data from cybersecurity risks, there is a wealth of resources with best practices on securing data as it is transferred between systems, stored and used.

One is the U.S. Department of Health and Human Services (HSS) Health Sector Cybersecurity Coordination Center (HC3). Through the HC3, HSS regularly publishes Threat Briefs that highlight relevant cybersecurity topics and raise awareness of current cyber threats, threat actors, best practices and mitigation tactics.

10. Barriers to achieving full interoperability

Achieving healthcare interoperability is a complex endeavor with several barriers. These obstacles range from technical challenges to organizational and financial issues. Among healthcare decision makers surveyed, 60% said barriers such as poor data quality and information sharing remain challenging to healthcare interoperability.

1. Outdated, legacy IT systems incapable of integration with other systems and integrated end user processes present a significant roadblock. For example, a hospital with a state-of-the-art, cloud-based ERP system in supply chain but an outdated point system for inventory management in clinical areas might find they cannot automate data sharing between the two platforms. This can lead to complex, costly and time consuming workarounds in an attempt to get data from one system to the other.

2. Lack of data standards is another challenge to interoperability in healthcare, not only within a hospital's walls but out to their suppliers and other business partners. For example, while medical device manufacturers have enumerated their products with U.S. Food & Drug Administration (FDA) unique device identifiers (UDIs), many healthcare providers lack the technical capabilities to use UDIs for supply tracking, management and documentation.

The aforementioned barrier presents risks to patient care and safety. For instance, if the manufacturer is using its UDI to identify a device but the hospital is using some other identifier within its systems (e.g., product number, catalog number, proprietary identifier), it will likely take more time and effort to locate devices subject to a recall.

Conclusion

Healthcare interoperability is a top priority for healthcare industry stakeholders not only in the U.S. but across the globe. Recent evidence of this was demonstrated when the World Health Organization (WHO) and HL7 signed the Project Collaboration Agreement to support global adoption of open interoperability standards in July 2023.

Healthcare interoperability streamlines business and administrative processes, improves patient health information accuracy for provider and payer organizations, and can support value based care delivery by facilitating impactful data analysis around the cost and quality impacts of specific interventions.

While tremendous progress has been made in healthcare, both in patient care delivery and in the supply chain, all stakeholders face challenges - from standardizing data for seamless sharing to protecting it from cybercriminal during transfer, storage and use.

Disclaimer: The third-party contributor of this piece is solely responsible for its content and accuracy, and the views expressed do not necessarily reflect the opinion of GHX.

Kara L. Nadeau

Healthcare Industry Contributor