Interoperability: Barriers and How to Achieve it Efficiently

Introduction

In simple terms, interoperability means the ability of systems and devices to exchange data as well as interpret that data. For 2 systems or devices to be interoperable, they must exchange and as well as present the data so that it is understandable to the user.

However, in healthcare interoperability means for all the systems and software to communicate and exchange data and be able to use and understand this exchanged data. The standards and rules should allow data to be shared across labs, pharmacies, clinics and patient regardless of the vendor. Healthcare interoperability is crucial to saving lives as it aids in effective delivery of healthcare for patients.

The path to achieving interoperability

The path to interoperability should be like a direction and not an end point. A level of interoperability should be implemented across all nations for all healthcare providers. Easy to use, standardized solutions should be used to communicate with other healthcare providers and  exchange data on a secure and effective network. There have been steps to standardize reporting and data structure but progress has been slow.

Attaining true and effective interoperability requires considerable cooperation and coordination between the stake holders and an industry-wise collaboration. The stakeholders along with healthcare need to share the responsibility of this fruitful project. Healthcare industry is very complex no doubt and is built on silos. The first step is to identify the importance of healthcare interoperability. Secondly, all the stakeholders need to identify the barriers faced to interoperability. Thirdly, they need to work together to minimize these roadblocks by implementing standards that facilitate nationwide interoperability.

For instance, to interoperate the nursing sector this is just one element of the healthcare industry, the multiple nursing terminologies and jargons need to be standardized on SNOMED-CT and LOINC standards. This may be challenging, but the future is a shareable and comparable data for patients worldwide.

The barriers to interoperability

As mentioned before, achieving interoperability is a very challenging task which is slow to progress. Nonetheless, it is extremely important to achieve as the Department of Health and Human Services (HHS) reported that 20 percent of preventable medical faults are due to lack of instant access to health information. They went as far as to say that one in every seven primary care visits is affected due to missing information.

1. Too many data: Interoperability is difficult due to the extent of information there is available which makes it very complex to standardize. For instance, a simple 10 second CT scan gives 10GB worth of raw data. The growth in data will just increase threefold in the future, and this poses a unique storage challenge to the healthcare industry.
2. Shortage of electronic data: Many healthcare providers do not have medical records, prescription summaries, health history, etc. in electronic form.
3. Lack of education on IT options: Hospital executives are not fully aware or educated about the IT options which will help them attain interoperability. Executives should ask about standards for interoperability whenever any IT purchase is made and think beyond the particular hospital’s need.
4. Include semantics: Problems arise in the path of interoperability as many products and software are simply not semantically interoperable with each other.  For example, one software may refer to heart attack as a myocardial infarction in its HER whereas the other might call it a heart attack. Doctors will know that both terms mean the same thing, but the system will not.
5. Products do not fit existing infrastructure and systems: The existing infrastructure in healthcare organizations is not compatible to attain interoperability. Since existing infrastructure cannot be used, it will have to be integrated into the new one which is difficult and expensive to do so.
6. Legal Barriers: The federal and individual state restrictions on releasing medical records are also an impediment in the way of interoperability. For instance, data just as mental health, HIV status, etc is not released so easily.
7. Poor quality data: Interoperability is also difficult to attain due to the duplication of data, incomplete data and multiple listings of the same patient (e.g. John Smith vs. Adam J. Smith)

What are the best practices?

The technology to attain interoperability already exists but some practices are to be implemented to attain interoperability fully.

1. Examine the vital domains

To avoid any pitfalls, identify potential missteps. One should firstly examine the industry standards and best practices in the public sector. The 5 major domains vital in health information exchange are:

1. Data governance,
2. Finance (sustainability)

• Technical infrastructure

1. Business
2. Technical operations and legal/policy

Overlooking these domains will lead to loss in the long term, increased costs and low provider adoption. Poor planning will pose problems for you in the long term and you may not be able to manage new care models.

2. Use the real world lessons

Learning from the real world mistakes is also essential in avoiding pitfalls. A lot of research is present on interoperability, but it has never been put into action as they are very complex and conceptual.  Moreover, they overlook the real life complexities that exist in the community such as providers’ distinct workflow and electronic health records (EHRs), a health care system’s existing technology investments, loans, etc.

3. Have the right people to support this paradigm

It is essential to have the right physician and administrative leadership to attain interoperability. This is a colossal investment of time and money and needs the right sponsorship and farsighted leadership to achieve.

4. Employ industry wide efforts

A few people cannot reach this difficult goal of interoperability. There needs to be input and work from staff members, the community partners, technology vendors, and executives of the health care industry.

What does the ideal state look like?

It is aimed to attain complete interoperability by 2024. In 2024, the ideal state of interoperability should enable the right data to be available to the right people at the right time. This should be available to all products and all organizations in a reliable way and should be understood by everyone.

By 2024, everyone from individuals to care providers to communities, and also researchers should have a selection of interoperable IT products and services that will enable the health care system to continuously learn and improve health care. It should also lower health care expenses, improve general health of the people and be a driving force for innovation