Finding Opportunities to Improve Interoperability

Healthcare organizations need to capture information that can support patient care, operational workflows, regulatory requirements, and multiple other uses of health data. Much of that data also needs to move between applications and across organizational boundaries. As it moves, having a consistent way to identify and understand what is being exchanged becomes increasingly important.

The United States Core Data for Interoperability (USCDI) helps establish consistency be defining a standardized set of health data elements for exchange. Each organization still determines how those elements are incorporated into clinical and operational workflows, including where the information is captured, who maintains it, and how it can be reused. Those decisions affect whether the information needed for exchange can be captured and maintained reliably.

Although USCDI is specific to the United States, the same considerations apply elsewhere. Canada, for example, is developing the Canadian Core Data for Interoperability (CACDI), along with national specifications to support consistent health information exchange. While standards and requirements differ between jurisdictions, the need to connect standardized data with clinical and operational workflows remains the same.

Use existing work to improve alignment

Many EHR workflows in place today were designed based on the requirements and technology available at the time. As interoperability standards evolve, there may be opportunities to improve how some of the information in those workflows is captured, structured, or coded. Reviewing every workflow solely for USCDI alignment would require significant time and resources, but interoperability improvements do not need to be addressed through a separate initiative.

Instead, standardization and interoperability needs can be considered whenever related workflows or configuration changes are already being evaluated. An upgrade, optimization initiative, regulatory change, or clinical project may already require the team to review how specific information is captured, coded, or used. Keeping interoperability in view during that work provides an opportunity to identify where better alignment may be possible.

In some cases, that review may simply confirm that the existing data and mappings continue to support exchange. Medication data, for example, is already highly structured in most healthcare organizations, with established terminology supporting multiple clinical and operational uses. A project touching the medication catalogue may confirm that the existing approach continues to support interoperability needs without requiring significant changes.

Other areas may reveal a greater need for change. For example, a project involving nursing intake documentation may uncover substance use information that is generalized or captured in free-text. Reviewing the fields, terminology, and mappings as part of that work can identify where changes may improve alignment with USCDI.

Keep the original scope in view

Identifying an opportunity for better alignment does not necessarily tell the team what would be involved in addressing it. Some initial review may be needed to understand how the information is currently being captured and whether the opportunity appears contained or could extend into other build areas or workflows. How far that investigation should go also needs to be considered within the scope of the work already underway.

Transportation access provides a good example. If an admission reassessment is being updated, the team may be familiar with the transportation access elements of USCDI and decide to take a closer look at the existing documentation. That initial assessment could lead to two different situations:

➡️ The opportunity appears contained. An appropriate structured field already exists in the admission assessment and updates to align with USCDI can be incorporated without requiring broader configuration or workflow changes.

➡️ The opportunity appears broader. Transportation information appears to be documented across admission, social work, discharge planning, and other workflows spanning multiple build components. Understanding what would be required to improve alignment may involve additional workflow analysis and stakeholder involvement.

Existing uses and dependencies also need to be understood before making any changes. Information being considered for standardization or interoperability may already be used by other workflows, reports, or system functions. Changes to how it is captured, structured, or mapped need to take those existing dependencies into account, which may further clarify whether the opportunity is contained or has broader impacts.

Once the team has enough information to understand what may be involved, they can determine whether the opportunity fits within the current work or should be considered separately through the appropriate governance and prioritization process.

Consider changes as standards evolve

Standardizing data to support interoperability is not a one-time build, but every new USCDI version does not need to trigger a separate redesign effort. As elements are introduced or changed, organizations can identify where they intersect with planned upgrades, optimization work, regulatory initiatives, or other projects already requiring workflow and configuration changes.

Some changes may warrant more immediate attentions, while others can be addressed when the related workflow is next reviewed. Over time, this allows interoperability alignment to evolve alongside the systems and workflows that produce and maintain the data.