Interoperability Primer and Playbook for Public Health and Healthcare Organizations

For standards-based interoperability readiness and safe, secure electronic health information exchange.

EXECUTIVE BRIEF

Analyst Perspective

Health and healthcare organizations prioritizing interoperability will improve data exchange capacity and capability. This will ensure rapid, safe, and secure gathering, sharing, analyzing, and reporting of electronic health information, resulting in reduced costs and improved health at both the individual and population level.

What is interoperability and why is it important?

Overview

Interoperability refers to the ability of two or more computer systems to exchange, communicate, and make use of information to optimize health outcomes for individuals and populations.

To achieve interoperability, we must adopt and optimize electronic health record (EHR) technology and health information exchange (HIE) services. For health and healthcare organizations, standards-based interoperability enables authorized users from multiple locations to access, gather, integrate, and share electronic health information quickly and securely. Outcomes include better care coordination among healthcare organizations and improved nowcasting, forecasting, and scenario modeling among health and human services organizations.

We have reached the tipping point. Nearly 90% of providers use EMR/EHR technology and 72% use certified EMR/EHR technology. Nearly 70% are recording social determinants of health information. Across all hospital types, more than 95% have certified EHR technology and 70% are integrating data into their EHRs from sources outside their health systems. Like EHRs, HIE services must also be optimized, adopted, standardized, and used by healthcare providers, their patients, and public health practitioners in order to advance interoperability.

It will take time for all types of health IT to be fully interoperable. When interoperability is achieved across health and healthcare systems, and the widespread exchange of information becomes standard practice, providers and health and human services organizations will have the infrastructure to deliver patient-centric and population-centered, value-driven accountable care that improves health outcomes while reducing costs.

The Vision

Working diligently to move closer to a streaming 360-degree view of the patient and population and to foster a health and healthcare system that can attend to patient and population needs in real-time – especially during a crisis like the COVID-19 pandemic. Interoperability is the critical diagnostic and assessment/policy development/assurance/facilitating tool required to achieve these goals.

Neal Rosenblatt
Principal Research Director
Info-Tech Research Group

Executive Summary

Your Challenge

Public health and healthcare response and preparedness will be driven by real-time data that allow health and healthcare organizations to quickly identify when and where infectious disease outbreaks and chronic diseases occur and maintain insights about health system capacity (ONC 2021).

The challenge CIOs and their IT leadership teams are facing today include:

• No single source of truth for data integration and curation.
• Multiple copies of data in different formats.
• Large movement of unstandardized data and system capacity to handle it.
• Increased pressure for faster and more efficient data integration and sharing.

Focus on standards-based interoperability to provide timely, safe, and secure access, integration, and exchange of electronic health data so that it can be used to optimize health outcomes for individuals and populations automatically and in real time.

Common Obstacles

Business landscapes and models are rapidly evolving, and users and stakeholders are becoming more data-centric, with maturing expectations and demands for data access and automated, real-time analytics, reporting, and sharing.

Primary barriers or obstacles that prevent organizations from improving or addressing those challenges include:

• Weak alignment with core functions and essential services business capabilities.
• Lack of awareness or knowledge of the importance of interoperability – definitions, types, standards, and standards implementation.
• Infrastructure immaturity and lack of preparedness for participation in interoperable health information exchange networks at the state, provincial, and national levels.

Common Obstacles

Effective approaches to interoperability will result in better outcomes for population health and improved efficiencies – including cost reductions and maturity of infrastructure, platform, and data exchange services – across health and healthcare organizations.
Enterprise-wide operational improvements will be realized by:

• Building awareness and knowledge of interoperability definitions, types, and standards.
• Gauging the impact of interoperability through capabilities mapping by assessing the defining, supporting, and enabling capabilities for interoperability readiness.
• Learning about interoperability and how it affects both your organization as a whole and IT specifically, including challenges and opportunities.

Info-Tech Insight

This research is designed to help public health and healthcare organizations overcome several challenges by focusing on standards-based interoperability to optimize health outcomes for the individuals and populations they serve.

Your challenge

Interoperability challenges experienced today by health and healthcare organizations including providers, researchers, and public health professionals, continue to present difficulties with the usability of health information systems due to their shortcomings in supporting core function capabilities, the provision of essential services, and addressing stakeholder needs.

Source: AHIMA 2017

This research is designed to help health and healthcare organizations overcome these challenges by focusing on standards-based interoperability to optimize health outcomes for the individuals and populations they serve at foundational, structural, semantic, and organizational levels.

Source: ONC and CMS, 2020: Survey Results: Readiness for the ONC and CMS Interoperability Rules

Common obstacles

If creating an interoperable health IT ecosystem is the key to unlocking the future of health and healthcare, and with so many benefits, why is it so difficult to accomplish?

• Competing interests
• E.g. financial, staff, and other resources
• Complexity
• Cost
• Lack of coordination between health systems, organizations, and agencies
• Inconsistent and lack of technical standards
• Numerous software systems with varying data standards
• Divergent health information privacy policies
• Differing approaches to gaining patient/individual consent
• Difficulty getting major EHRs to coordinate with each other
• Data gaps across different EHR applications and networks
• Data silos across the ecosystem that would inform the most urgent and impactful patient and/or population interventions
• The regulatory landscape continues to become increasingly complex:
• Rule revisions for government-sponsored programs occurring on a yearly basis
• Adds to providers' doubts as to whether technologies like machine learning can adapt to these constant regulatory changes

Source: Philips, 2022: The Future Health Index 2022 report

Info-Tech's approach

Unlock the value of interoperability.

The Info-Tech difference:

• Building awareness and knowledge of interoperability definitions, types, and standards.
• Gauging the impact of interoperability through mapping and assessing defining, supporting, and enabling capabilities for interoperability readiness.
• Learning about interoperability and how it affects both your organization as a whole and IT specifically, including challenges and opportunities.

1. Capability Mapping
• Use the Capability Mapping tool as an interoperability readiness assessment process.




2. Interoperability Assessment
• Identify interoperability types (foundational, structural, semantic, and organizational) across your organization.




3. Interoperability Implementation

• Build types and standards into your organization's interoperability ecosystem one use case at a time.

• Interoperability Ecosystem

Executive brief case study

The future enablement of health interoperability outcomes 2030.

In May 2021, the Office of the National Coordinator for HealthIT (ONC) launched a project called "Health Interoperability Outcomes 2030." The project asked health and healthcare practitioners (n ≈ 700), "What should 2030 look like because of interoperability?" Outcome statements were collected and analyzed for trends, groupings, and combinations. The result was a prioritized set of interoperability outcomes focused on the end state of individuals having internet-based access to their electronic health information, setting the course for aspirational and achievable goals by 2030.

INDUSTRY: Government/ HealthIT
SOURCE: The Office of the National Coordinator for HealthIT

An aspirational vision of interoperable health systems by 2030

• The health system will enable evidence-based, precision care that accounts for the social and health conditions of each patient, including links between health and human services.
• The health system will more quickly identify high-risk conditions, chronic diseases, and disparities in health equity.
• The data used for clinical and administrative processes will be electronically integrated to support decisions about payment, eligibility, and benefits.
• Public health response and preparedness will be driven by real-time data that allow public health agencies to quickly identify when and where infectious disease outbreaks occur and maintain insights about health system capacity.
• Reporting for public health, quality measurement, and safety will all be completed automatically and electronically.
• Researchers will be able to use inclusive, representative datasets to compare the real-world performance of treatments, procedures, devices, and drugs.
• Research and testing for new decision support, workflows, and other work processes will be able to be conducted across multiple sites and among different technologies.
• Researchers and health professionals will spend little to no time normalizing data for research and quality activities.
• Preventable data-related safety events will be reduced to zero.
• Health professionals will spend less time on administrative tasks and more time caring for their patients.
• Duplicate diagnostic tests and procedures will be reduced.

Source: ONC 2021 | Synthesized statements that reflect respondents' overall sentiment about what health systems should look like in 2030 because of interoperability.

Insight summary

Overarching insight

This research is designed to help health and healthcare organizations overcome several challenges by focusing on standards-based interoperability to optimize health outcomes for the individuals and populations they serve.

1 Insight – Definitions and Levels

1.0 Standards-based Interoperability in health and healthcare organizations provides timely, safe, and secure access, integration, and use of electronic health data so that it can be used to optimize health outcomes for individuals and populations.

1.1 Health and Healthcare organizations prioritizing interoperability and standards will see improvements in data access, integration, management, retrieval of data and documents, scientific staff productivity, IT efficiencies, cost optimization, and data exchange capabilities. This ensures quick, safe and secure gathering, analyzing, and sharing of electronic health information in ways that follow all industry and HIPAA protocols.

1.2 Standards-based interoperable HIT solutions are becoming fundamental building blocks driving digital transformation, enabling financial efficiencies, and supporting standards development as well as the implementation, operation, and use of standards-based HIT solutions – specifically for services integration, cloud computing, cybersecurity, and information safety.

2 Insight – Standards Development

2.0 Standards provide a common vocabulary, code sets, structure, and guidelines that enable interoperability between systems and/or devices.

2.1 In order to seamlessly ingest and curate information without effort, standards permit clinicians, labs, hospitals, pharmacies, payors, patients, health information exchanges, healthcare services, and public health organizations to share data regardless of application or market supplier.

2.2 Interoperability standards development works to increase the adoption of emerging and mature health IT standards to further align existing and emerging standards and implementation guidance with strategic healthcare policy goals to achieve improved health outcomes for people everywhere.

2.3 With the expansion of data and information exchange partners, along with the shift to value-based care, a broader range of data types have become available to inform on more complex and integrated health and care decisions, including data pertaining to the social determinants of health.

3 Insight – Standards Implementation

3.0 Health and healthcare organizations seeking to acquire or improve their health information systems need a convenient, reliable way of specifying a level of compliance to standards sufficient to achieve efficient interoperability for digital and data modernization.

3.1 Some standards development organization (SDO) entities create standards. Others bundle complementary standards into profiles that are used to define a specific function or use case. This provides implementation guidance that describes how multiple standards can be used together to support interoperable information exchange.

3.2 The different SDOs generally follow shared principles based on developing standards through a multi-stakeholder, consensus-based process to respond to a specific industry or market need.

4 Insight – Testing and Conformance

4.0 Organizations like the Global Consortium for eHealth Interoperability, which was co-founded by HIMSS, IHE International, and HL7 International, work to amplify and align the work of organizations like IHE and HL7 to increase the adoption of emerging and mature health IT standards. The consortium's primary goal is to coordinate work with governments and national ministries of health to further align existing and emerging standards and implementation guidance with strategic healthcare policy goals to achieve improved health outcomes for people everywhere.

5 Insight – Interoperability Ecosystem

5.0 An efficient interoperability ecosystem provides an information infrastructure that uses technical standards, policies, and protocols to enable seamless and secure capture, discovery, exchange, and utilization of health information.

Interoperability Playbook

Follow these best practices to make sure your standards-based implementation requirements are solid.

Summary of Plays

1. Build awareness and knowledge of interoperability definitions, types, standards, standards-based implementation, and standards testing and conformance.
2. Gauge the impact of interoperability by using the capabilities mapping tool for assessing, defining, supporting, and enabling capabilities for interoperability readiness across your organization.
3. Develop an information infrastructure that includes all interoperability types, applicable standards, guides, and profiles.
4. Choose standards that have been vetted by rigorous testing and conformance efforts.
5. Build types and standards into your organization's interoperability ecosystem one use case at a time (e.g. the Info-Tech Social Determinants of Health blueprint).

Blueprint benefits

Developing and deploying world-class interoperating data and analytics exchange to meet today's and tomorrow's health challenges across health and care ecosystem landscapes. This includes all communities served at the individual, patient, and population levels.

Focusing on five key priorities that are interconnected and equally important to reaching the future interoperable state:

1. Building the Right Foundation: Improving data exchange infrastructure, collection, analysis, and sharing across health and healthcare organization information networks.
2. Accelerating Data for Action: Tapping into more data sources, promoting health equity, and increasing capacities for scalable outbreak response, nowcasting, forecasting, scenario modeling, and predictive analytics in real-time.
3. Developing a State-of-the-Art Workforce: Using next-generation skills for actionable health and care insights.
4. Supporting and Extending Partnerships: Breaking down silos, ensuring transparency, addressing policy challenges, and solving problems together.
5. Managing Change and Governance: Making sure resources are used wisely, monitoring progress, and supporting strategic innovation for new ways of thinking and working.