Towards Healthcare Interoperability: What Must Be Done?

Howard Chen is a radiology chief resident at University of Pennsylvania in the Healthcare Quality and Leadership pathway. Howard graduated from Harvard Medical School and Harvard Business School and was the recipient of the 2014 Imaging Informatics Open-Source Leadership Award from the Society of Imaging Informatics in Medicine. His peer-reviewed papers investigate the role of data science in patient care, radiology education, and computational genomics. Howard writes about creating value for patient care through informatics and innovation. He tweets under @howardpchen.
Interoperability is becoming the most sought-after in healthcare, but needs further standardization.
A few days ago, Walgreens announced a new deal with Epic Systems, joining numerous health systems (and one of its major competitors, CVS) by implementing Epic's famous electronic health records (EHRs). In its press release, Walgreens cited interoperability as one of the primary reason for this transition:
 

“This state-of-the-industry EHR will enable more seamless communication with health systems and local providers, and gives us enhanced capabilities to deliver better health outcomes through greater care coordination and interoperability.”


Interoperability has become the holy grail of technology adaptation in many industries.

What Is Interoperability?

Its importance is better shown by examples where interoperability is absent. Everyone who's switched cellphone carriers in the past 10 years may have wondered why the same phones for AT&T could not be used for Verizon. Or in Europe.

The cell phone towers are in 2 incompatible formats: GSM and CDMA. A CDMA phone cannot be used in GSM, the way software has to be separately developed for Microsoft Windows and Mac OS X. Despite supporting very similar sets of hardware (phones) and transmitting similar types of information (radio wave signals), the incompatibility arises from how data is exchanged. Protocols, standards, and application programming interfaces cause these networks to remain non-interoperable.

Contrast this example with WiFi. All WiFi-enabled devices are compatible with WiFi without having to worry about different specifications because the 802.11 standard has been adapted as the universal standard.

Interoperability in Healthcare

Healthcare information technology (IT) began like cellphone towers. At its inception, a patient's record in 1 EHR could not be copied to a different vendor's solution without significant work. In today's highly distributed American population, with 7.3 million people moving to a different state every year, we can no longer rely on a single health record.

When I go to my doctor in Philadelphia, she needs to see my x-ray back from when I lived in Boston. A cancer patient's doctor needs to be able to get chemotherapy and radiation treatment records and load them into his or her own system to continue the therapeutic pathway. When a car crash victim is sent by helicopter across the state to a level 1 trauma center, even overnight express Fed Ex is too slow for a computed tomography scan to arrive on a DVD.

Therefore, it comes as no surprise that the ability to exchange information emerges as the new holygrail for EHR providers. The Healthcare Information and Management Systems Society defines interoperativity at 3 levels.
 
  • Foundational Interoperability refers to the ability to send data from one IT system to another.
  • Structural Interoperability refers to the ability that allows specific data fields within a piece of information to be exchanged, thanks to a common data syntax.
  • Semantic Interoperability is at the highest level and referrs to the ability to seamlessly integrate healthcare information systems using not just a common structure but also a shared lexicon.
 


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