As one of the most rapidly changing industries, the health industry faced a lot of changes throughout the years. That’s how interoperability in health became a necessity from a distant and hardly achievable goal. Thirty years ago, healthcare systems functioned independently, and because of that, seamless exchange of information was almost impossible.
Technological advancements, regulatory initiatives, and industry collaboration all contributed to substantial progress. As a result, interoperability has empowered healthcare providers, patients, and IT developers as a tool to collaborate in building a fast, connected, and efficient healthcare system.
What is interoperability?
You probably heard it as a buzzword, especially in the context of healthcare. But what does it actually mean?
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Interoperability can be broadly defined as “the ability of two or more systems or components to exchange information and to use the information that has to be exchanged.”
From a healthtech perspective, it would be:
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The seamless exchange, interpretation, and utilization of data among various healthcare systems and applications.
The dangers of limited patient data
To bring the whole concept alive, let’s talk it through the story. Imagine a patient; his name is Jack.
Jack is visiting a specialist for a follow-up after being diagnosed with a complicated condition. The specialist receives Jack’s medical records in a physical format or through a non-interoperable electronic system. Data exchange is hard at this point, and he has limited access to Jack’s complete medical history. The information from other healthcare providers is unavailable or not easily shareable. This might lead to a wrong diagnosis, or the patient might get inaccurate treatment.
The specialist makes manual updates and prescriptions on Jack’s medical record. He then sends it to Jack’s local pharmacy. The pharmacist has no way of knowing Jack’s medical history, allergies, or other medications he might be taking at the time.
You can see that limited access to patient data might lead to fragmented and incomplete care. And as we can all surely agree, a higher percentage of errors and delays in helping the patient is something nobody wants in health.
Exchanging data in healthcare
To better understand how healthcare systems communicate and exchange data, we need to explore the principles of interoperability first. Through my work and research, I have encountered various fundamental principles. For the purpose of this blog, let us delve into four specific ones:
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Technical
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Syntactic
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Semantic
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Organizational
They all play a vital role in connecting different systems and ensuring information flows smoothly. Let’s break down simple terms and real-world examples to demystify interoperability.
1. Technical interoperability
Technical interoperability ensures basic data exchange capabilities between systems (for example, moving data from a USB stick to a computer). This requires communication channels and protocols for data transmission. With today’s digital network and communication protocols, achieving technical interoperability is usually relatively straightforward. However, moving data from point A to B is not enough. Technical interoperability is in place when technical requirements are met, and two or more systems are connected.
Jack’s electronic health record (EHR) system can securely exchange data with a hospital's system, allowing specialist records to be seamlessly transmitted and accessible within Jack’s EHR.
2. Syntactic interoperability
Syntactic interoperability specifies the format and structure of the data (for example, in an XML document, JSON, etc.).
International organizations are developing standards to support the exchange of health data. One emerging standard is HL7. Health Level Seven refers to a set of international standards for transferring clinical and administrative data between software applications used by various healthcare providers.
FHIR (Fast Healthcare Interoperability Resources) defines common healthcare concepts that can be accessed and exchanged using web technologies. FHIR is gaining popularity in the health industry because it enables the development of mobile health apps that can work on different IT systems.
Another worldwide initiative, openEHR, aims to improve the structured exchange of health data by allowing medical professionals and health IT experts to define clinical content using archetypes. They are specifications or templates that define the structure and semantics of clinical concepts.
Let’s revisit our friend Jack:
He is paying a visit to a specialist again. The specialist uses an electronic prescribing system to generate a prescription for Jack's medication. Through syntactic interoperability, the prescription is formatted and transmitted using standardized messaging protocols, such as FHIR.
The prescription is received by Jack’s preferred pharmacy, which also utilizes a system that supports syntactic interoperability. The pharmacy system can accurately interpret the prescription's structure and content as it uses the standardized format. This ensures that the pharmacy system correctly understands important details such as medication name, dosage, and instructions.
3. Semantic interoperability
Semantic interoperability ensures that the meaning of medical concepts can be shared across different systems using medical terminologies, nomenclatures, and ontologies. This provides a common digital language for medical terms that can be understood by humans and machines worldwide. An example is SNOMED CT, with its extensive collection of over 340,000 medical concepts. It is well-suited as a general-purpose language for promoting semantic interoperability in medicine and healthcare.
Jack visits a specialist for a follow-up appointment. The specialist can access Jack's medical records from various healthcare providers through semantic interoperability and understand the information consistently. Thanks to standardized medical terminologies and coding systems, they instantly identify Jack's diagnosis, treatment history, and medication details.
4. Organizational interoperability and seamless healthcare
At the highest layer, interoperability also involves organizations, legislations and policies. Exchanging data across health IT systems is not an end but should, ultimately, help healthcare professionals work more efficiently and improve patients’ health. This requires common business processes and workflows that enable seamless healthcare provision across institutions.
As always, different stakeholders in healthcare have different interests, and these interests do not always aim to maximize interoperability. This requires policies that provide incentives for interoperable data exchange and, if necessary, enforce interoperability via legal regulations.
Imagine if Jack is receiving care from multiple healthcare organizations. A primary care clinic, a laboratory, and a hospital. These entities work together seamlessly through organizational interoperability to ensure coordinated and efficient care.
When Jack visits the primary care clinic, the clinic's electronic health record (EHR) system allows them to access and update Jack's medical information. This includes vital signs, medical history, and any ongoing treatments. Information is securely shared within the organization, enabling continuity of care and informed decision-making by the primary care provider. If the primary care provider determines that Jack needs further tests, they can electronically send the lab requisition to the laboratory.
The laboratory will receive the requisition and perform the test through organizational interoperability while accessing Jack’s relevant medical information. If the laboratory identifies a critical finding that requires immediate attention, an automated alert is sent to the primary care clinic and the hospital’s emergency department. This triggers a coordinated response and ensures accurate and timely results. In our case, it means Jack will receive prompt and appropriate care.
As you can see, interoperability offers numerous advantages that directly impact the cost and delivery of patient care. By improving clinical outcomes, streamlining operations, and enhancing patient and provider satisfaction levels, interoperability can benefit all involved parties. This results in saving a lot of time and money across all healthcare systems. Research indicates that implementing interoperability could result in annual cost savings of up to $30 billion while also significantly enhancing patient care and safety.
The power of interoperability
Digital medicine does not necessarily mean complex AI algorithms and advanced analytics. In many cases, making the right information available to the right person at the right time can significantly improve patient care.
As some of you have experienced, critical medical details often disappear as patients go through the healthcare system. For example, if a patient is hospitalized, relevant information from previous visits to other hospitals may not be available. This leads to inefficiencies in care, posing serious risks for patients. Lack of communication can even result in adverse drug interactions.
To avoid such ineffectiveness, giving healthcare providers the necessary information is crucial. This will undoubtedly take the quality of care to the next level.
What are the benefits of achieving interoperability in healthcare?
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Improved patient care - with seamless data exchange, healthcare providers can comprehensively view a patient's medical history. This leads to more accurate diagnoses and personalized treatments.
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Reduced healthcare costs - Interoperability eliminates the need for redundant tests and procedures, saving both time and money.
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Enhanced public health - Sharing data across systems can help identify trends, track outbreaks, and inform policy decisions.
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Empowered patients - Patients can access their health records more easily, allowing them to take control of their healthcare and make informed decisions.
How interoperability is the key to seamless healthcare
Reading this text, we can understand that interoperability is improving healthcare. But, to have the full closure let’s get back to our boy Jack and his specialist. The difference, this time, is that we have a fully interoperable system in place.
Jack is visiting a specialist for a follow-up after being diagnosed with a complicated condition. This time the specialist accesses Jack’s electronic health record (EHR) based on the interoperable FHIR standard. The FHIR API allows the specialist to seamlessly retrieve Jack’s comprehensive medical information from different healthcare providers, including his primary care physician, previous lab results, and medication history. With access to Jack’s complete medical history, the specialist can make much better decisions and provide accurate treatment plans for his condition.
During the visit, the specialist updates Jack’s EHR with the new details from the examination. All the details are instantly available to other healthcare providers involved in his medical care. In the end, the specialist also electronically sends a prescription to Jack's local pharmacy.
FHIR standard enables seamless communication between specialists and pharmacies. The pharmacist receives the prescription and accesses Jack’s EHR, which includes his complete medical history, allergies, and current medications he is using.
Jack’s example demonstrates that the future of healthcare interoperability is bright. But, as in every case, there are still some obstacles to overcome. Data privacy and security, data standardization and consistency, technical infrastructure and compatibility, and more are all important considerations.
There are a lot of new things I expect to happen in that field, including more data flow across all fields, widespread standardization thanks to standards such as FHIR, mass adoption, AI-driven insights, and increased patient empowerment. Overall, it will result in more connected, efficient, and patient-centered healthcare systems, improving health outcomes and revolutionizing how healthcare is delivered and experienced by all.
Who are we to offer perspective on this topic?
At Devōt, we have a lot of experience with healthcare technology, and currently, my team and I are focused on helping our clients implement FHIR in their software solutions. As a result, I can surely confirm the quote from Deloitte’s paper, “It’s like plumbing. It’s not sexy, it’s not visible, but when implemented correctly, it can enable a whole new world of care delivery and patient empowerment.”
Whatever “sexy” means to you, if you are interested in learning more about this topic, feel free to reach out to us!
