What does the Term Interoperability Mean in Healthcare?
How do we define the various stages of interoperability? And for healthcare, which stage are we looking to achieve?
In the world of health tech, the term 'interoperability' seems to be everywhere these days. Looking back over the past decade, the term wasn't foreign to most - but wasn't exactly at the forefront of strategic planning either. (We've been quite busy just trying to move off of paper!) Now, interoperability has become so important that the U.S. has health legislation focused around the term.
In a news release published on April 24, 2018, the Centers for Medicare & Medicaid Services (CMS) wrote:
"We are proposing to overhaul the Medicare and Medicaid EHR Incentive Programs to focus on interoperability, improve flexibility, relieve burden and place emphasis on measures that require the electronic exchange of health information between providers and patients. To better reflect this new focus, we are re-naming the Meaningful Use program 'Promoting Interoperability'."
It's been over a year since the rebranding of Meaningful Use took place. Reviewing some of the more recent CMS documentation got me thinking about a couple of things ...
1) What on earth does interoperability mean anyways?
Cambridge Dictionary defines the term interoperability as "the degree to which two products, programs, etc. can be used together, or the quality of being able to be used together." Sounds straightforward enough. ... Well, except for the word 'degree'. It turns out that we can break interoperability down into various stages. So what are they? And which one do we need to strive towards to make healthcare connections meaningful?
Foundational interoperability is the basic connection of two systems to exchange data. System A sending information to system B. For example, the transmission of a pdf document to a data repository. An important thing to note with this level is that the receiving system does not need the ability to interpret the information.
Structural interoperability takes things a bit further than foundational. Instead of general information exchange, the information has discrete elements. This is the preservation of the purpose and meaning associated with the data. An example of this would be a hospital system sending information on visit history to a separate patient portal. The hospital EHR sends messages that adhere to a defined and detailed structure. The portal application can receive the information and parse out where each data element should go. (This allows the visit date to file to a certain discrete field, and the visit reason to file to another.)
With semantic interoperability, we start to get a bit more purposeful. It's great to have viewable data from other systems, but it's much better to be able to use that data in a meaningful way. With this stage of data exchange, the receiving system has the ability to use the data for functionality within the application. Using a primary care physician's office system as an example. Lab results from an outpatient lab visit could be electronically sent over. The electronic medical record (EMR) used by the physician can then incorporate the data into the application and trend it over time. [With information from many sources displaying together in the graph(s).] To achieve this level of interoperability both the sending system and the receiving system need to have codified data. (For example LOINC coding for lab results.)
The final and most comprehensive stage of interoperability is organizational. This is what we are striving for. Data, policies, and social meanings from two or more systems seamlessly interact. When we need them too. For me, this is where my iPhone can access and send my comprehensive health-related data to people I choose. From anywhere in the world that I travel to. The recipient(s) systems would be able to distinguish between data that was from medical providers, and data that I entered on my own. Health professionals could also pull up my relevant information, as they need it, from everywhere I've sought care. (With my permission of course.)
2) Will a CMS focus on interoperability be able to impact the industry the way Meaningful Use did?
Whether you love it or hate it, there is little doubt that the Meaningful Use program in the U.S. had a huge impact on the global use of technology in healthcare. The U.S. Office of the National Coordinator for Health Information Technology tracks key statistics on the adoption of technology on various dashboards. Looking back to 2008, a paltry 9% of U.S. hospitals has a basic electronic health record (EHR) in place. Fast forward to 2015 and that number jumped to 84%. [The Health Information Technology for Economic and Clinical Health (HITECH) Act was passed by Congress in 20019. This is the legislation that led to the Meaningful Use program.]
The U.S. is a hub of tech innovation. Many of the large global EHR vendors are based out of there. Meaningful Use requirements played a big role in the EHR implementation over the past decade. With vendors focusing heavily on this, global organizations were able to reap the benefits.
I'm hoping this new U.S. legislative focus on interoperability will be the catalyst we need to move data exchange forward in a significant way. ... And that we don't have to wait too long to see it happen.
Who knows .... maybe, one day we can catch up to the finance industry. Imagine a world where healthcare data exchange is as seamless (and trusted) as paying for things with Apple Pay. Or as easy as depositing checks from anywhere by taking a photo using your banking app. Where providers and patients alike have access to meaningful comprehensive data where they need it when they need it.
"Coming together is a beginning; keeping together is progress; working together is success. - Henry Ford.