Learn About Interoperability

Learning Objectives

After completing this unit, you’ll be able to:

  • Define the three I’s of data sharing.
  • Explain why interoperability is important.
  • Describe how Health Cloud enables interoperable systems.

Over the years, how we manage patient records has evolved from manually filing papers to maintaining digital records. Hospitals and clinics use electronic health records (EHRs), but they use different kinds of EHRs that are often incompatible. Consider a patient like Charles Green, who was referred to StayHealthy Hospital for an emergency procedure. His doctor and his care team are handling his case at Bloomington Caregivers. Bloomington Caregivers uses an EHR, but the hospital uses a different EHR. To provide the care that Charles needs, Meena Sen, a nurse at StayHealthy Hospital, has to switch back and forth between the two EHR systems. Because Charles’s health history data is disparate and siloed, it’s difficult for Meena to get a complete view of her patient.

There’s a lot of data coming in from many different sources. The data is disconnected and lacks context. This is a nightmare for care coordinators trying to piece together the case history of a patient. Care coordination becomes time-consuming and cumbersome and then there’s little time left over for preventive care. Add to this a crisis, such as a pandemic, and the result is pandemonium.

However, there is a remedy. To ensure that patient information from disparate EHRs is available to all providers, care teams, and IT systems, we need an interoperable system that enables data sharing.

The Three I’s of Data Sharing

Connected data sharing relies on three things.

  • Interface
  • Integration
  • Interoperability

First, we need an interface to enable two separate systems to share data. This is important because it establishes the pathway to share information. Essentially, an interface helps move data between systems.

Next, we need integration. Integration brings together the many interfaces that support business process automation within an organization, making sure that they all work together as a whole.

Interoperability takes integration to the next level. It’s the process of getting computerized systems and software applications to connect, exchange data, and interpret data with unambiguous, shared meaning within and across organizational boundaries. Information systems talk to each other using a single, shared language without adding complexity. Interoperability does this by enabling computer systems to transmit data with increasing sophistication across four key levels.

Four Key Levels of Interoperability
FOUNDATIONAL
Establishes the interconnectivity requirements needed to securely exchange data between systems
STRUCTURAL
Defines the format, syntax, and organization of data exchange, including at the data field level for interpretation
SEMANTIC
Allows for common underlying models and codification of data, providing shared understanding and meaning
ORGANIZATIONAL
Includes governance, policy, social, legal, and organizational considerations to facilitate the secure and seamless flow and use of data, both within and between organizations

Interoperability isn’t the same as integration. Although integration brings together disparate systems, it doesn't carry the context of the information. In contrast, interoperability uses integrated connections to drive meaning across systems by providing context to data. Integration, therefore, is fundamental to interoperability.

Why Do We Need Interoperability?

Healthcare is moving toward a 360-degree view of each patient. Together, all the medical systems create a complete view of the patient. EHRs communicate seamlessly with each other when they are interoperable systems. In the United States, the 21st Century Cures Act (also known as the Cures Act Rule) aims to promote interoperability among disparate EHRs, and the MyHealthEData Initiative empowers patients to access and control their own health information. As part of MyHealthEData, the Interoperability and Patient Access rule focuses on driving interoperability and patient access to health information (patient data). The Cures Act Rule and the Interoperability and Patient Access rule both emphasize secure data exchange and patients’ rights to access their own health information. Interoperability is critical for rapid scaling of healthcare systems and secure exchange of health information.

What Health Cloud Offers

Health Cloud brings together medical information from different EHR sources to support interoperability. By providing an engagement layer that sits on top of different EHRs, Health Cloud breaks down data silos and brings health data together on one screen. 

Interoperability can be achieved at both the backend and the frontend. At the backend, data from an external system is copied to Health Cloud, and may optionally be stored. In the frontend (the Health Cloud user interface), the data presented is pulled in real time from an external system by a process called data virtualization. 

Health Cloud also offers some added functionalities with OmniStudio and MuleSoft. 

  • OmniStudio offers preconfigured, customizable express orgs that are layered into Health Cloud. These orgs can also integrate with external systems (when used with added functionalities such as DataRaptor).
  • MuleSoft Anypoint Platform connects data, devices, and applications across clinical and nonclinical IT systems.
  • MuleSoft Accelerator for Health provides APIs, connectors, and integration templates to bring together patient data from different EHRs.

With Health Cloud, OmniStudio, and MuleSoft, care coordinators can access a 360-degree view of a patient, with data from any EHR system.

In the next unit, you learn about the HL7v2 and FHIR R4 standards and what they mean for Health Cloud.

Resources

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