Achieving true interoperability across the care continuum has been a top priority for providers, payers, and other key stakeholders for more than a decade. The HITECH Act in 2009 saw providers move from paper-based records to EHRs. However, achieving 100% interoperability is still feat healthcare must achieve to realize coordinated and patient-centric care. Here’s a brief history of interoperability and how much still needs to be achieved.

Healthcare Interoperability: The History

Since the 1980s, messaging standards- notably the international HL7 standards- have played an instrumental role in furthering the idea of interoperability in healthcare. For instance, the HL7 V2 standard enabled the sharing of information between systems, such as Patient Administration Systems, Electronic Health Records, and Laboratory Information Systems. HL7 v3 was released in 2003 is meant to support data workflows between providers. FHIR is the latest HL7 standard and utilizes a web-based approach to connect disparate systems and data elements.

Barriers to Interoperability

  • The Complexity of Healthcare Systems

The healthcare system involves multiple entities,. including providers, nurses, ambulatory centers, and lab technicians working in collaboration to deliver patient care. Therefore, there is a constant inflow and outflow of data from each of these points. The exchange of information also contains different types of data ranging from clinical data to organizational information that is often incompatible with vendor-driven software. 

  • Legacy Systems with Limited Interoperability Capabilities

These are the systems implemented prior to national standards coming into the picture. Such systems have issues in achieving interoperability, and most of them are programmed in a way to limit interoperability with other systems for security concerns or to protect market share.

  • High Data Exchange Fees

High costs associated with data sharing is another interoperability hurdle. Some vendors charge money up to $50,000 for data exchange.

 Levels of Interoperability 

  • Functional

Functional interoperability is the most basic tier and is the ability of one IT system to send data to another IT system.  This exchange is not concerned with whether the recipient system can decipher or interpret received data. The recipient system must only be able to send a confirmation to the source system about the receipt of the data payload.

  • Structural

Structural interoperability is the intermediate tier where one IT system sends data and the recipient IT system interprets the information at the data field level. However, the clinical information contained in the source message remains intact and unaltered even after being received by the destination system

  • Semantic

Semantic interoperability is the ability for two or more health IT systems to exchange as well as to decode the information to deliver insights for improving patient outcomes. This is the highest level of interoperability and fuels the vision of connected care and allows physician networks and other stakeholders to share patient data and facilitates better decision making and promotes coordinated care.

Why Interoperability is the Need of the Hour

  • Reduction of medical errors

When patient records are scattered across physicians’ offices, labs, and hospitals, there is a risk of EHR mismatch and harm to patients as care extends beyond the provider’s facility. 

  • Integration of Health Records

The healthcare system thrives on data and vast volumes are always circulating, whether it’s from subsystems such as laboratories, operating rooms, primary care providers, and even via patient wearables. With interoperability, these disparate data sources can be brought together into a common platform and then analyzed to deliver insights to the point of care. Not only can data from independent systems be unified, but it can also help providers, healthcare organizations, and vendors to work in collaboration to deliver better patient care.

  • Better management for chronic conditions

At a time when chronic diseases account for around 75% of US healthcare spending, there can’t be a more opportune time for providers and healthcare systems to work in collaboration. Achieving interoperability would empower provider networks as managing chronic conditions involve care administration via multiple touchpoints. Lack of interoperability standards or poorly enforced standards can obstruct seamless health data exchange by complicating transactions and posing additional barriers to the flow of information.

The above figure represents the modern data and analytics architecture powered by interoperability. If you take a closer look, the entire process consists of four stages:

  1. Sourcing: A vast pool of data from various sources that include clinical, operational, streaming, scientific and external data with different formats that are not only disparate but unable to be processed and understood at the point of care. Until the data is extracted and integrated into a common platform that complies with a set of technical standards able to communicate with each other.
  1. The API-Bridge: The API-bridge allows for seamless data sharing from different sources in recognizable formats for two or more Health IT systems. With this bridge, the data can be interpreted to serve insights to providers and other crucial points in healthcare delivery.
  1. Curate and Enrich: This layer supports the creation of longitudinal patient records that contain the complete history and story of the patient, thereby allowing providers to act upon that information to deliver better care.
  1. Organize and Analyze: Provider networks and health systems can leverage a data aggregation engine and cloud technology to ingest data from all identified sources having requisite security permissions. This data storehouse can be cleaned, segregated, and analyzed with technologies such as Big Data and Hadoop to deliver insights via mobile apps to providers and other stakeholders at the point of care, improving their operational efficiency

 The Journey to Interoperability: Where do We Stand Currently?

Although healthcare interoperability has achieved tremendous progress, there is still plenty of ground to cover.  Here are a few facts and evidence that would highlight healthcare’s ongoing journey to interoperability:

  • According to a brief by the Office of National Coordinator for Health IT (ONC), only 60% of all hospitals use a health information exchange for data sharing.
  • About 50% of the hospitals face challenges when exchanging data across a different platform.
  • 36% of the hospitals reported their providers rarely or never use received electronic information when treating their patients.

How Healthcare Can Navigate the Challenges on the Road to Interoperability

  • API-First Approach

FHIR uses a standardized application programming interface (API) standards that allow for any EHR to feed information directly into the provider workflow that eliminates gaps and errors that may happen in paper-based or document-based exchange. 

  • Adoption of a standardized terminology

Standardization of the format and content of healthcare data is the need of the hour to ensure data flow complies with standard terminology that is understandable to computer systems, physicians, caregivers and patients all-alike.

  • Educating/Training Physicians

Healthcare providers need to be educated about the use of ICT tools so that they acquire the necessary technical skills to do away from redundant tasks and switch to electronic systems and records for everyday patient activity.  In fact, the use of technology to simplify healthcare operations must be reflected in the DNA of healthcare.

The Road Ahead

ONC has created the Interoperability Standards Advisory (ISA), a set of standards and implementation guidelines to encourage interoperability. Apart from that, ONC is also promoting Fast Healthcare Interoperability Resources (FHIR) – a plug-and-play service that enables healthcare apps to seamlessly exchange information and interact with each other. The growth in EHR adoption has been impressive; however, it still has a long way to go. With more and more healthcare data coming up on the front lines with each passing second, providers need to find new ways of monitoring, deriving insights, and achieving interoperability is a failsafe way to achieve these goals.


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Abhinav Shashank is the CEO and co-founder of Innovaccer, a leading San Francisco based healthcare technology company. He built the foundation for Innovaccer’s success as a leader in population health management and machine learning-oriented healthcare solutions recognized by Gartner, KLAS, Forbes, Black Book Market Research, and others. Abhinav’s continued efforts and ambition enabled the company to flourish in health information technology in the U.S. and acquire over 25 healthcare organizations as customers, with more than 25,000 providers using Innovaccer’s solutions daily. His continued work and focused approach have resulted in the latest round of Series C investment led by Dragoneer, Tiger, Steadview Capital and M12, Microsoft’s venture fund. With his vision for seamless care delivery using unified patient records, Abhinav is now leading the team towards $1 billion in savings for U.S. healthcare. Additionally, Abhinav Shashank is an influential thought leader and a renowned author. Abhinav has published over 300 articles for various international media outlets, was bestowed a coveted spot in Forbes “30 Under 30 Asia 2017: Enterprise Tech” and was recognized by Becker's Hospital Review as one of the ‘Top 60 rising leaders in U.S. healthcare under 40’ in 2019.

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