Healthcare Integration & Interoperability — A Mini Series

Completely inspired from my trip to HIMSS last week, I thought it made sense to talk about healthcare interoperability, connectivity and the component pieces to making this happen. This mini series is broken up into several parts that will cover:

  1. What is connectivity and interoperability?
  2. File protocols, formats and requirements, i.e. HL7 (including discussions on version 2 vs. 3), DICOM, EHI, and CCD;
  3. Transport protocols and interfaces: MLLP, TCP/IP, FTP, etc.;

Part 1: What is Healthcare Integration and Interoperability?

According to HIMSS, healthcare integration “is the arrangement of an organization’s information systems in way that allows them to communicate efficiently and effectively and brings together related parts into a single system.” †

The 2006 White House executive order defines Interoperability as (section 2 paragraph c):

Interoperability” means the ability to communicate and exchange data accurately, effectively, securely, and consistently with different information technology systems, software applications, and networks in various settings, and exchange data such that clinical or operational purpose and meaning of the data are preserved and unaltered.

Reference

These are great standard definitions and allow you to understand the difference between the two. Integration relates to how systems can work or collaborate for a common purpose, e.g. a patient management system working with a scheduling system. Interoperability speaks to how these systems are connected, in order to provide a continuous flow of information that improves care for the patient.

In order to achieve Interoperability, systems must be connected in a secure way, authenticating all users and allowing one healthcare application to share data with another anywhere in the country, without compromising a patient’s privacy.

From a real world scenario, what this means is that all systems must be integrated in order to achieve interoperability, i.e. a physicians patient management system must be able to authenticate and securely connect to a hospitals EMR; Ambulatory centers to pharmacies; hosted EMRs to wound treatment centers. Patient information can no longer live in just one place.

Interoperability Dimensions

(As defined by HIMSS)

  • Uniform movement of healthcare data
  • Uniform presentation of data
  • Uniform user controls
  • Uniform safeguarding data security and integrity
  • Uniform protection of patient confidentiality
  • Uniform assurance of a common degree of system service quality

No Small Task

Connecting all of these systems is no small task and is as much of an organizational challenge as it is a technological one. People and healthcare systems no longer exist within a vacuum and teams need to collaborate to make integration projects happen. These same people will need to agree on the best way to solve the connectivity problem and rely on the guidance of Health Information Service Providers to come up with solutions that meet the needs of all while adhering to the mission of improving patient care. As we continue to move forward in achieving interoperability, the scope and magnitude and of what needs to happen cannot be underestimated and careful planning must take place.

Throughout the mini-series, we will discuss the component pieces that are involved in achieving interoperability including application interfaces, file protocols, transport protocols, security & authentication, and compliance.

The Goal

Integration and Interoperability are significant pieces of the Meaningful Use objectives and the mission is to improve the care of individuals while providing them with secure, ubiquitous access to their health information. While there is no one way that can solve the challenge of interoperability, understanding the mission and the various parts of the goal can help make achieving connectivity as prescribed by the ONC and Meaningful Use.

Healthcare Interoperability Panel Discussion

Part 2 | Part 3



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