Interoperability in Healthcare Systems
Successes and New Challenges to Value-Based Healthcare Management.
In the healthcare industry, interoperability is the ability of different information systems and software applications to communicate and exchange data and use the information exchanged. The use of standards and data exchange models enables this information to be shared between healthcare providers, professionals, patients, hospitals, pharmacies, laboratories, etc. regardless of the application being used. (1)
Improving patient safety and continued care
Interoperability is of particular value with regards to increasing patient safety, as it allows access to and availability of clinical patient data. Moreover, access to clinical patient data in real time allows healthcare systems to treat patients from any point of care within the system, thus improving its quality and efficiency.
It is imperative that the different healthcare systems are able to exchange information and transfer it from one system to another via specific interfaces, adapted or customized, that structure information similarly.
Interoperability: The Tower of Babel of healthcare systems
Healthcare systems have spoken different languages for a very long time, making communication and interaction difficult between them. The risk was ending up like the people in ancient Mesopotamia who wanted to build the famous tower, but were unable to fulfill their goal of touching the sky when everyone suddenly started speaking in different languages and were overtaken by great confusion that prevented them from culminating the monumental tower.
To achieve the smoothest possible exchange of information, it is essential to adopt standards for the different health systems to share. For this reason, several organizations seeking to unify interoperability criteria have arisen, such as HL7 International, HIMSS o NEMA.
The healthcare industry has developed and has appropriated standards for various purposes related to messaging, terminology, documents, conceptual frameworks, application and architectures, both for syntactic interoperability, based on the structure of communication, and for semantic interoperability, which refers to the meaning of the communication.
In messaging for example, they have developed standards that define the format and structure of data elements to facilitate communication between different clinical systems. Among these are:
- HL7 V2.X, HL7 V3 to exchange demographic, clinical and administrative data.
- DICOM (Digital Imaging and Communications in Medicine) that defines the way to communicate diagnostic images and information associated with these.
- ASC-X12, which has been designed to exchange procedures, patient eligibility and benefit payments.
- IEEE 1073, which determines the messages to exchange data with biomedical instrumentation equipment.
With regard to health terminology or data standards that add the semantic component, vocabularies and codes have been developed to label clinical concepts such as diseases, problem lists, diagnoses, drugs, techniques and procedures, analytical determinations and laboratories, among others. Some of these are:
- ICD-10 or the International Classification of Diseases, that defines a catalog of diagnoses and procedures for statistical purposes, billing, costs and paperwork.
- LOINC that is more oriented to laboratory tests, metrics and clinical observations.
- SNOMED CT, which is a large ontology of biomedical concepts with descriptions, relationships and grammar to build clinical expressions.
Among the standards for documents used to indicate the type of information to be included in a document and how to structure the content sections, are the HL7 CDA (Clinical Document Architecture), CCDA (Consolidated CDA) and CCR (Continuity of Care Record) that define a consolidated view of patient summary health information, including allergies, treatment, care plan and list of active issues, for the purpose of sharing information between healthcare professionals.
In conclusion, interoperability is a means to an end and not an end in itself that becomes more efficient and powerful with the use of standards. Nevertheless, there is a significant number of healthcare standards that may hinder interoperability decisions between the different systems that a medical center must interact with, so it is important to properly define and establish the policies, standards and guidelines to be implemented.
Interoperability of clinical data in healthcare systems: Success stories
In the last few years, healthcare systems have been working to connect, share and use patient information throughout the hospital network more efficiently and with better results. Despite the complexity of interoperability, there are many success stories in Spain that demonstrate that interoperability between different health systems is possible. One such case is the Electronic Health Record project launched in 2006, which has enabled controlled access to patient information from any point of care, whether primary or specialized.
Another more recent success story is the project to make electronic prescriptions interoperable throughout the Spanish territory, which was launched in 2015. By early 2017, 9 of the 17 autonomous communities are expected to be incorporated into a single national electronic prescription system.
In addition to the convenience for people travelling to other regions, either for tourism or other circumstances such as family reasons, the interoperability of electronic prescriptions provides greater control of drugs and patient safety.
Unified Health Record implemented in the network of 30 hospitals in the capital of Mexico: The Ministry of Health of Mexico City recently announced the digitization and real-time shared access project for patient data in the federal capital of Mexico. The 30 hospitals serve a population of 4 million.
Thanks to the ehCOS technology platform, all the patient care systems in the 30 hospitals have become interoperable with each other in just two years, increasing patient safety and continued care from any point of care in the capital. This has also increased the efficiency of the healthcare system and decreased the costs of retesting, since this information is now shared and used in real time.
The Medical Administration and Hospital Information System (SAMIH) has transformed the patient care process in Mexico City.
Implementation of Electronic Birth Certificate (CEN) in Mexico
Communicating and exchanging information about newborns in Mexico has been a challenge that involves exchanging and using the information recorded for every newborn in order to start their medical care from that very same day through the Electronic Health Record. This single record will now manage the newborn’s illnesses, vaccinations, accidents, hospitalization, surgery, treatments, allergies and everything related to their health throughout their lives. This has been a breakthrough in terms of access and rights to healthcare services, as it is a single format for each patient that guarantees their identity and protects their rights.
CEN has already been implemented in 16 states in the Mexican nation, and to date more than 50,000 birth certificates have been issued. Thanks to the interoperability achieved using the ehCOS technology platform, the CENs are simplifying the distribution, issuing, capture, protection and availability of health information of the citizens born in Mexico, It is also improving the security and privacy of information by incorporating advanced electronic signature, digital stamps and electronic biometric information.
The challenges of interoperability in the changing paradigm of value-based healthcare management
Up to now, interoperability had focused primarily on facilitating communication, exchange and use of patient information between healthcare providers and patients to some extent.
Given the paradigm shift of value-based healthcare management that healthcare systems are embracing, interoperability must broaden its scope and ensure the exchange of patient information between all actors that participate in managing and maximizing healthcare value, including hospitals and healthcare providers in general, patients, government, insurers and other providers of the healthcare ecosystem.
(1) HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations, 2nd Edition, 2010, Appendix B, p190.
Article updated after the publication of the Interoperability: The Tower of Babel of Healthcare Systems article. [in Spanish]