Interoperability Standards in Healthcare: A Work in Progress

When people in the healthcare industry talk about interoperability, their definitions can vary. "Interoperability" has different meanings for IT professionals, chief technology officers, physicians, and so on. But discussing interoperability standards in healthcare truly requires starting with a shared meaning.
 

The Healthcare Information and Management Systems Society (HIMSS) provides a good basis. It 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."¹
 

To see ideal patient coordination in the healthcare field, establishing interoperability standards is essential. The field has a long way to go, and IT teams are an invaluable resource in implementing solutions.
 

The Case for Interoperability in Healthcare

As spelled out by the HIMSS definition, the patient care case for interoperability is clear: There must be seamless access to patient data that supports patients across the care continuum. Steve Holloway, Executive Director at Signify Research, refers to this as data liquidity and acknowledges that "how the data flows through the system and is available and accessible to different parts of the care management pathway is a real challenge." But solving for this challenge could unlock a number of benefits.
 

Interoperability across and within health systems makes it easier to access and deliver care where the patient needs it. In an emergency situation, this could save lives, but even in regular patient encounters, it leads to improved outcomes through better, more efficient and data-driven patient care.

There's also a business case to be made. Healthcare interoperability supports the integration of various data and systems in ways that reduce the administrative burden and increase visibility into data. Here are a few potential benefits:
 

• Integrate across the organization. Interoperability allows for data communication within a healthcare system. For instance, it supports medical device integration, which can streamline workflows. Being able to easily swap data among medical devices, labs, operations, etc.—and making it accessible—supports organizational efficiency.
• Improve business and administrative processes. When internal systems talk to each other, it can eliminate time-consuming tasks such as processing patient intake information. Likewise, integrating appointment scheduling, patient portal, and medical billing software with the electronic medical record (EMR) allows information to flow where it's needed, minimizing redundancy and human error. It can even help with materials management, as having interoperable clinical accessories can make it easier to expand the capabilities of medical equipment and replace consumables.
• Simplify reporting. Healthcare systems work within a network of interested parties, from groups that need to use universal codes, terms, and measurements to regulatory patient privacy and security standards. An efficient ecosystem will have an infrastructure that's optimized by interoperability.

Striving for Healthcare System Interoperability

Interoperability, however, remains elusive. Consider this: At least 70% of healthcare providers still exchange medical information via fax.² The obvious problem is that EMRs don't always mesh evenly across different health systems. This inability for pieces of medical records to "speak" to each other means important data from an outside specialist or emergency department may not make it into the patient's record. Even within a system, EMR data may not fully integrate with specific lab or clinical decision support tools.³ This can result in costly inefficiency, diagnostic delays, and gaps in care that can lead to poor patient outcomes.
 

And while systems are trying to achieve a greater level of interoperability, even more data is being generated by even more sources.
 

Mark Urness, an ultrasound connectivity leader for handheld at GE HealthCare, estimates that on a scale of 1-10, health systems fall around 6 in terms of taking interoperability seriously. That's not terrible, but as the technology evolves—for instance, as we add more portable and handheld devices—they need to be at least an 8 or 9, Urness says.
 

While it's not the case that anyone actively opposes interoperability, moving from concept to reality is tricky.
 

Common Barriers to Establishing Interoperability

Many challenges, both real and perceived, keep data siloed. Among the top issues are security, compatibility, and buy-in.
 

Security

Healthcare interoperability relies on data from connected medical devices, which can be potential entry points for cybercriminals. The problem isn't interoperability itself but that these devices are not always included in a hospital's security plan. That's one reason GE HealthCare has redoubled its efforts in this area: Every product has a privacy and security representative who works with the client to close the gaps.
 

Compatibility

Image data, lab results, medication orders, financial transactions, admissions documentation, and more all have different structures and workflows. As Urness explains, there may be a mix of unique or older systems that may not interact with each other or with new components smoothly without some human intervention. As new technology and data sources come online, IT professionals must continually audit their system's performance and security.
 

Provider Buy-In

Urness says a physician once told him, "Every click just kills me a little bit," speaking about the many steps that even a simple imaging exam can take. It's a bit of a paradox—healthcare interoperability solutions ultimately streamline workflow in the big picture, but they may require changes that users find frustrating to adopt. Guidance and support from the vendor and the IT team can make all the difference.
 

The Framework for Interoperability Standards in Healthcare

Interoperability requires standards, and the industry has been working on them for years. Integrating the Healthcare Enterprise (IHE) is an industry initiative to advance standards-based multivendor integration. It coordinates the use of certain established standards:
 

• HL7 is a set of international exchange standards for sharing data between healthcare providers.
• Fast Healthcare Interoperability Resources (FHIR) is an interoperability standard that emerged from HL7.
• DICOM is similar, but its standards focus on images.

These standards are just a framework: They provide a baseline, but they don't ensure interoperability. GE HealthCare and other vendors participate in developing interoperability standards for healthcare, but more work remains, especially for healthcare organizations.