Interoperability in Healthcare: The Key to Improved Patient Care

Healthcare interoperability refers to the ability of different information systems, devices, and applications to access, exchange, integrate, and cooperatively use data in a coordinated manner within and across organisational, regional, and national boundaries. This capability relies on established health data standards and information exchange frameworks.

It aims to provide seamless and secure access to health information, facilitating optimal health outcomes for individuals and populations. In other words, healthcare interoperability ensures every organisation, regardless of their computer systems or management systems standards, operates off of the same play book and ensures optimal patient care.

The seamless sharing of electronic health data amongst doctors, hospitals, payers and patients is no longer a convenience, but an essential component for effective healthcare provision. However, for health data interoperability to function well, healthcare systems must adhere to agreed-upon standards and protocols.

In this article, you’ll learn:

Interoperability delivers numerous benefits that enhance patient care, streamline operations, drive innovation, and improve public health outcomes across the healthcare ecosystem. Let's explore these benefits from multiple perspectives:

• Empowered Decision-Making: Patients can make informed decisions with a comprehensive view of their health data.
• Improved Care Quality: Providers can access complete patient records, reducing the risk of medical errors and improving outcomes.
• Better Access: Patients can easily access their health records, promoting engagement and informed decision-making.

• Streamlined Operations: Clinical workflows become more efficient, reducing administrative burdens.
• Comprehensive Patient View: Access to a complete patient history enables more accurate diagnoses and treatment plans.
• Enhanced Collaboration: Easier sharing of information facilitates better coordination among different healthcare providers.

• Improved Claims Processing: Access to comprehensive patient data can expedite claims processing and reduce errors.
• Enhanced Fraud Detection: Interoperable systems allow for better monitoring and detection of fraudulent activities.
• Data-Driven Policy Design: Access to broader healthcare data enables the creation of more effective and tailored insurance policies.
• Cost Reduction: Streamlined data exchange can lower administrative costs and improve operational efficiency.

Interoperability in healthcare opens up numerous opportunities for developers, medical technology companies, and startups. Here's how it impacts this sector:

• Innovation Acceleration: Interoperability standards create a level playing field, allowing startups and tech companies to develop new healthcare solutions more rapidly. This environment fosters innovation by enabling easier access to diverse healthcare data.
• Streamlined Development: Standardised data formats and APIs significantly reduce barriers to entry for new technologies in the healthcare market. This streamlining allows developers to focus on creating value-added features rather than struggling with data integration issues.
• Enhanced Connectivity: Interoperable systems facilitate robust connectivity between various healthcare technologies, enabling the creation of more comprehensive and integrated solutions that can work seamlessly across different platforms and organisations.
• Scalability and Adoption: Interoperable solutions are more easily adopted across different healthcare organisations, allowing for faster scaling of new technologies and broader market penetration.
• Value Demonstration: The ability to combine clinical, device, and other data for analytics allows MedTech companies to demonstrate the value of their solutions to patients, payers, and providers across the healthcare ecosystem more effectively.
• Lifecycle Optimization: Interoperability enables MedTech companies to leverage data to improve every stage of their product lifecycle, from research and development to post-market surveillance and value-based care contract administration.
• Real-World Evidence: Access to interoperable healthcare data facilitates the collection and analysis of real-world evidence, which is crucial for regulatory compliance, product improvement, and demonstrating effectiveness in real-world settings.

By embracing interoperability, developers and MedTech companies can create more innovative, connected, and valuable healthcare solutions that address the evolving needs of the healthcare industry and contribute to improved patient outcomes.

• Longitudinal Health Record: Integration of member clinical, claims, and SDOH data from disparate sources into a single normalized dataset.
• Better Clinical Outcomes: Data-driven insights enable timely notifications to care managers, providers, and members for improved health outcomes.
• Administrative Cost Savings: Automation of data analysis and repetitive processes allows employees to focus on higher-level functions.
• Reduced Provider Abrasion: Auto-population of clinical inputs and expedited processing of prior authorizations and claims streamlines provider interactions.
• Optimal Risk Adjustment: Integration of clinical data enables more accurate assessment of members future health and well-being.

Interoperability involves distinct levels of data sharing capabilities, from basic system connections to complex data integration across the healthcare ecosystem.

Let's go over the three main areas of interoperability:

Foundational interoperability is the lowest level of interoperability. The transport mechanism (such as an HL7 messaging system) does not understand the medical data it's carrying, but the data is packaged in a standard format so a receiving system (like a hospital's Electronic Health Record system) can process and interpret it.

This level ensures systems can exchange information using established data exchange schema and protocols, forming the basic foundation of health information technology infrastructure

Example: A hospital's electronic health record (EHR) system sending a patient's laboratory results to a regional health information exchange (HIE) platform.

In this scenario, the HIE platform receives the data, but it doesn’t need to interpret or act on it beyond storing it or making it accessible. The primary goal is ensuring that the data can move from one system to another.

InterSystems Health Connect™ provides this level of interoperability by sending HL7 V2 messages from the sending system (laboratory) to either an Electronic Health Information System or Electronic Medical Record. The message is packaged through a standard schema such as HL7 V2 but is not otherwise interpreted.

This level of interoperability is crucial for networked computerized systems to exchange health data classes effectively.

The next level of interoperability is structural interoperability (or syntactic interoperability). Each element of data is understood by a receiving system based on where it is in the structure. Both the format and structure of data exchange are standardized. This includes uniform movement of healthcare data from one system to another, maintaining the meaning of the data during the transfer process.

Example: A primary care provider sends a referral to a specialist.

The referral information, including patient data, diagnosis, and reason for referral, is formatted and structured in a standardized document format, such as HL7 Clinical Document Architecture (CDA), ensuring that the specialist's system not only receives but also displays the information correctly. This preserves both the data's structure and intent.

InterSystems HealthShare® can receive and send CDA documents and make them readable in the clinical viewer.

Semantic interoperability is the highest level of interoperability and requires that data is standardised so two or more systems can not only exchange data, but can interpret and use the information meaningfully, supporting interoperable health information exchange across the healthcare industry.

Semantic interoperability requires standard data models and codification of data, using terminologies such SNOMED CT or ICD-10 codes, so data is understood consistently across different systems.

Example: Two different healthcare facilities use EHR systems developed by different vendors. A patient treated at both facilities has their health information, including diagnoses and treatments, coded in standardized terms (e.g., SNOMED CT for clinical terms and ICD-10 for diagnoses).

Despite the different systems, when one facility shares data with the other, both can understand and interpret the information correctly, ensuring that treatments are based on a comprehensive understanding of the patient’s health history.

InterSystems FHIR® server can process FHIR messages generated by an EHR in one health system which employs several different healthcare terminologies defined through FHIR profiles. Interoperability in Healthcare:Another system can then read these FHIR resources from the InterSystems FHIR repository and achieve semantic interoperability.

As we've explored, interoperability is all about how health systems work together effectively. These standards provide the framework for achieving this goal.

In the United States, health information technology standards are established by organisations like The Office of the National Coordinator for Health Information Technology (ONC). These include the United States Core Data for Interoperability (USCDI), which defines essential health data standards for nationwide exchange.

Here are key standards supported by modern healthcare technology:

HL7 V2: Health Level Seven (HL7) V2 is a standard language for sharing and integrating electronic health information. It's widely used for seamless integration of information inside and outside hospitals, streamlining clinical and administrative processes.

HL7 FHIR: Fast Healthcare Interoperability Resources (FHIR) is a newer HL7 standard. It provides technology for handling FHIR, including client and server components, a message model, and translation between FHIR and other health information exchange standards.

CDA (Clinical Document Architecture): CDA is an XML-based standard that specifies the structure and semantics of clinical documents for information exchange.

C-CDA (Consolidated CDA): C-CDA 2.0 is an implementation guide containing templates for 12 clinical documents, including the Continuity of Care Document (CCD) template. It harmonizes efforts from HL7, Integrating the Healthcare Enterprise (IHE), and Healthcare Information Technology Standards Panel (HITSP).

DICOM (Digital Imaging and Communications in Medicine): DICOM ensures interoperability of systems that produce, store, display, process, send, retrieve, query or print medical images, and manage related data and workflow.

Direct Secure Messaging: This standard provides a simple, secure, scalable, standards-based way to send authenticated, encrypted health information directly to known, trusted recipients over the Internet.

Prescription Standards

SCRIPT: Provided by the US National Council on Prescription Drug Products (NCPDP), SCRIPT is a standard for e-prescribing, covering information exchanges related to medications, supplies, and services within the healthcare system.

X12: X12 is a standard for business-to-business electronic data interchange (EDI), covering transactions such as order processing, shipping information, invoicing, and health insurance claims submission and adjudication. It is primarily used inside the US.

These standards work together to create a comprehensive framework for healthcare interoperability, enabling efficient and accurate exchange of health information across various systems and organisations.

Aside from data standards, healthcare interoperability involves several parts that work together to allow data sharing between different systems.

Here are some main components:

EHRs are digital patient charts that store medical information. They are often the main software used by healthcare providers and a vital part of integrating digital health products. Reading and writing data to EHRs is necessary for a fully digital health system.

These are the steps clinicians follow when providing patient care. Each healthcare organisation often has its own set of workflows, which makes integration more challenging. Fitting into the right workflow is important for digital health tools to be used and grow.

Software for managing insurance claims and patient billing plays a critical role in healthcare operations. These systems need to integrate with EHRs and other clinical systems to ensure accurate and efficient billing. They are essential for financial operations and reporting, bridging the gap between clinical care and financial management.

Medical devices, including vital signs monitors, imaging equipment, wearable health tech, and remote monitoring devices, generate crucial patient data. These devices need to integrate seamlessly with EHRs and other clinical systems to ensure real-time data flow, supporting comprehensive patient care and informed decision-making.

Virtual Private Networks (VPNs) are often used for secure communication with hospital networks. Other options include SFTP or HTTPS, and some hospitals may use TLS (Transport Layer Security) to protect data being sent.

While integrations handle data transactions individually, maintaining records of these transactions is essential. This practice ensures regulatory compliance and supports important business operations.

Proper data storage and backup allow healthcare organisations to meet legal requirements, conduct audits, analyse historical data, and recover information when needed.

Protecting sensitive healthcare data is very important. Companies that help with integration should follow best practices and meet standards such as NIST Cybersecurity Framework, GDPR, and HIPAA.

All parts of handling healthcare data — sending, processing, and storing — must follow HIPAA rules (or other governing standards outside the US). Whether using in-house tools or outside help for integration, making sure everything follows HIPAA is a must.

Knowing about these parts helps in dealing with the difficulties of healthcare integration and creating good ways to share data between systems. As things change, staying informed about these components and how they work together will help in setting up and growing healthcare integration systems.

InterSystems IRIS for Health™ plays a pivotal role in this ecosystem by offering a robust platform designed specifically for the demands of healthcare data management and interoperability. It provides a comprehensive solution for developing healthcare applications with high demands for data integration, processing speed, and scalability. With its deep support for healthcare data standards such as HL7 FHIR, InterSystems IRIS for Health ensures that applications built on its platform can easily exchange data with other systems, fostering greater interoperability.

Interoperability in healthcare extends far beyond just clinical data exchange. It encompasses a wide range of scenarios involving various stakeholders, including providers, payers, patients, and public health entities. Here are some expanded examples that showcase the breadth of interoperability in healthcare:

HIEs allow secure sharing of health information among physicians, hospitals, and other healthcare providers. They improve the speed and accuracy of diagnosis and treatment, reduce medical errors, and enhance patient engagement.

For instance, when a patient visits an emergency room, the attending physician can quickly access the patient's complete medical history from various providers through the HIE, leading to more informed decision-making.

This involves the expedited exchange of information between healthcare providers and payers, along with automated processing.

Examples include:

• Electronic Prior Authorization: Plans eliminate 50-70% of prior authorization submissions by responding real-time to provider queries via their EHR and streamline adjudication of remaining requests using FHIR APIs to access supporting clinical information.
• Closure of Time-Sensitive Quality Gaps: Plans notify treating providers of time-sensitive HEDIS care gaps with sufficient time and specificity to intervene based on automated analysis of ongoing clinical documentation feeds.
• Data-Driven Shared Savings: Plans and providers advance value-based care by auto-populating dashboards needed by frontline caregivers and care managers to enhance care coordination for individual members and population health management.

Interoperability enables patients to access their health information through patient portals or personal health record apps. Patients can view their medical history, lab results, and medication lists from multiple providers in one place, empowering them to take a more active role in their healthcare.

These systems integrate with EHRs to provide real-time, evidence-based recommendations to healthcare providers. For example, when a physician enters a prescription, the system can check for potential drug interactions or allergies based on the patient's comprehensive health record.

Interoperability allows data from medical devices (like heart rate monitors or glucose meters) to be automatically recorded in a patient's EHR. This ensures accurate, real-time data capture and reduces manual data entry errors.

Interoperable systems enable seamless telemedicine visits by allowing providers to access patient records from different sources. Similarly, data from remote patient monitoring devices can be integrated into the patient's EHR for continuous care management.

E-prescribing systems allow for direct, secure transmission of prescriptions from providers to pharmacies. This integration improves medication safety, reduces errors, and enhances efficiency.

Interoperability facilitates the aggregation of data from multiple sources for research purposes. For example, researchers can access de-identified patient data from various healthcare systems to conduct large-scale studies or identify potential participants for clinical trials.

Care coordination platforms integrate data from various providers and settings to support coordinated care for patients with complex needs. For instance, a platform might bring together information from primary care, specialists, home health agencies, and social services to provide a comprehensive view of a patient's care plan.

This involves the integration of a health plan member’s clinical and claims data, upon their request, from prior and concurrent payers, as recently mandated by US regulations.

Examples include:

• Care Continuity: Care managers leverage data integrated from prior payer systems into new member health records to prevent gaps in medication for managing chronic conditions.
• Care Coordination: Treating providers informed by full longitudinal health record of patients who have recently changed plans or are dual-eligibles.
• Member Satisfaction: Plans reduce their “ask” of members to recall and re-input information already captured in other payer systems.

Organisational interoperability is the coordination and alignment of policies, procedures, and protocols across various healthcare entities, facilitating the seamless and meaningful exchange and use of health information.

It encompasses the collaboration and agreement among different healthcare stakeholders, including providers, payers, patients, and regulatory bodies, to ensure that information flows efficiently and effectively within the healthcare ecosystem.

For example, interoperable EHRs can facilitate the automatic transfer of billing information to financial systems, reducing manual entry errors and enhancing the accuracy of claims submissions

Key Benefits

Interoperability typically involves sharing patient data across different systems and organisations, which can create privacy and security challenges. Healthcare entities must navigate complex regulations like HIPAA while ensuring efficient data exchange and protecting medical records.

Relevant technologies/capabilities that would help with the challenge:

• Choose a database that offers robust security features, such as InterSystems IRIS for Health, which provides encryption at rest and in transit.
• Consider cloud deployment options that offer enhanced security measures and compliance certifications.

Healthcare providers often use different terminologies and coding systems, leading to semantic differences that can hinder true interoperability. Ensuring consistent understanding and use of health information across systems is crucial.

Relevant technologies/capabilities that would help with the challenge:

• Implement solutions with deep support for FHIR, HL7 V2, IHE, and other global healthcare information protocols and messaging formats. InterSystems products enable seamless integration and interoperability of health applications.
• Utilise data mapping and translation tools, such as those provided in InterSystems FHIR Transformation Service, HealthShare, and Health Connect, to convert information between different terminologies and coding systems.

Healthcare organisations often operate on various software platforms with differing data formats, making system integration a significant challenge for achieving interoperability.

Relevant technologies/capabilities that would help with the challenge:

• Invest in integration technologies like InterSystems Health Connect a high-availability, high-performance healthcare integration engine that can interface between disparate systems.
• Utilise middleware solutions that support multiple healthcare standards and can translate and route data as necessary, reducing the need for manual data conversion.

For effective interoperability, healthcare entities must ensure that data transferred between systems is accurate, complete, consistent, and timely.

This reliable data exchange is crucial for informed decision-making and improved patient outcomes.

Relevant technologies/capabilities that would help with the challenge:

• Implement a high-performance healthcare integration engine like InterSystems Health Connect, which ensures reliable and timely data exchange.
• Establish data quality assurance processes within your interoperability solution, such as those offered by InterSystems products, which can automatically check for data accuracy, completeness, and consistency.
• Utilise real-time data processing capabilities to ensure that critical health information is available to caregivers when needed.

InterSystems offers a comprehensive suite of solutions to address the complex challenges of healthcare interoperability. These solutions are designed to handle the diverse formats and sources of health data while preparing organisations for future technological advancements.

Health data comes in numerous formats, ranging from simple, standardised codes to complex genomic data files and diagnostic images. Related information such as social determinants, consumer sentiment, environmental conditions, and location tracking are equally important. Data sources are varied, including spreadsheets, health information systems, devices, social media sites, and government agencies.

InterSystems provides the equivalent of an electrical socket adapter and converter for health data, allowing your organisation to read and write data in any format as it travels through the health and care ecosystem.

• Purpose-built data platform for developing healthcare applications
• Supports rapid ingestion and integration of healthcare data in various formats
• Enables real-time analytics and application development

• Unified longitudinal health record for comprehensive member and patient information
• Supports care coordination and population health management
• Facilitates secure health information exchange

• Cloud-first, enterprise-grade healthcare integration engine
• Supports comprehensive interoperability with HL7 V2, HL7 FHIR, DICOM, and IHE profiles
• Provides real-time data integration and transformation for high data volumes
• Offers streamlined management and scalable integration in a cloud environment

• Provides, maintains, and manages high-performance FHIR computing infrastructure
• Enables leveraging of healthcare data from diverse sources
• Supports FHIR-based solutions for various healthcare challenges
• Backed by InterSystems experience in managing over one billion health records globally

1. Reduced time, cost, and complexity of integration with electronic health records and other clinical systems
2. Enhanced data quality and consistency across the healthcare ecosystem
3. Improved care coordination and patient outcomes
4. Increased operational efficiency and reduced administrative burden
5. Future-ready infrastructure capable of adapting to evolving healthcare technologies and standards

By leveraging InterSystems comprehensive interoperability solutions, healthcare organisations can overcome data silos, enhance information sharing, and ultimately improve patient care while preparing for the future of healthcare technology.

Healthcare interoperability improves patient care and makes healthcare operations more efficient. It allows different systems to share data seamlessly, which leads to better care coordination and patient outcomes. Healthcare organisations need to use standards like HL7 and FHIR, while following laws such as HIPAA, to share health information securely and effectively. These models can then be used to enhance diagnosis, treatment planning, and predictive analytics, further improving patient care and healthcare operations.

While creating a fully interoperable healthcare system presents challenges, the benefits are substantial and far-reaching. It not only improves patient care and system efficiency but also supports healthcare innovation, including the advancement of AI applications in medicine.

As we move forward, interoperability will continue to be a key driver in transforming healthcare delivery and outcomes.

If you want to improve your organisation's interoperability, InterSystems can help. We have the experience and tools to guide you through the process of connecting your healthcare data systems.

Our team can show you how to:

Contact us today to learn more about how InterSystems can help you improve patient care, stay compliant, and build trust with your patients.

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