J P Systems, Inc.

J P Systems, Inc.

Healthcare Interoperability

Interoperability is "the ability to exchange and use information, usually in a large and heterogeneous network ..." (wordnet.princeton.edu/perl/webwn).

 

soccer ballInteroperability is a team sport.

Many people might expect that medical data is as easy to exchange as banking or travel transactions. Unfortunately, medical data is much more complicated. This is further complicated by the fact that the actual data stored in the various Electronic Health Records (EHR) software systems uses differently coded look-up tables. One system might use a number, 10520, to represent a blood type, such as O+. Another system in another hospital uses a different number, 758492-1 for the same blood type. While another system just stores the text "O+". This makes it difficult to two healthcare providers to exchange anything but reports which have translated the codes back into letters understandable by a human.

International data standards, standardized terminologies and message standards are foundations of interoperability. These standards include guides for semantic standards, medical vocabularies and standardized laboratory test results.  There are thousands of different kinds of messages which can be sent to accomplish clinical goals.  Many clinical messages require an action to be done in the real world of a specific nature. For example, a doctor may be ordering a lab test.  Or a doctor may be sending a prescription to a pharmacy to be filled.  A laboratory order message requests that a lab test be done.

Before these messages can be integrated into an Electronic Healthcare System, they must be carefully defined.  Part of the design work which goes into implementing a clinical message is to describe the business processes and use cases which define the clinical process. Every individual aspect of the work done by healthcare providers to take care of patients with any type of disease or preventive care must first be designed and modeled on the level of all the possibilities of the business and IT processes.  HL7 is an organization dedicated to creating standards for the structure of each message type. Founded over 50 years ago, HL7 works to allow anyone in the world to exchange medical data.  Many countries are cooperating to make these international standards a reality.

Along with the clinical data, the security layers are transported. These govern who is allowed to see the data in the EHR record, and when and how could that be overridden in an emergency.  Roles and responsibilities are defined for each user.  A complex dance is orchestrated to run through who can see and or change information and under which circumstances this can occur.   Need to know protocols are invoked much like in a defense agency for patient safety.   

Interoperability Insights

Galen Mulrooney
80% of the challenge of interoperability is the establishment of practical and implementable data standards. The other 20% includes healthcare policy, human languages, and legal problems. This is a technical challenge which must be solved in an international arena with international standards so the effort and costs can be spread out between various countries. Canada, the U. K., Australia, Japan, Brazil, Italy, and Germany are already dedicated to data standards.
- Galen Mulrooney, V.P. J P Systems, Inc.

The ideal state of healthcare interoperability would be that of healthcare providers being able to send data to each other as easily as banks can now. The real state is that of a budget driven lack of cooperation to agree on a "standard" standard. Software vendors are a part of the puzzle. dddddd Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.
- Interoperability in the Real World Blog

Relevant Links

Downloads

  • FHIMS.org is a collaboration site for the Federal Health Architecture's Federal Health Information Model (FHIM)

Most resources for HIT interoperability are highly technical papers of use only to those who have been in the field for a long time.