Achieving Value With Interoperability

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By Justin Gernot, Vice President, Healthbox

Digital transformation is transitioning from a nice-to-have to a mission-critical element of any healthcare provider’s strategy. The HIMSS Digital Health Indicator (DHI) objectively measures a provider organization’s progress toward a digital health ecosystem that enables consumers to manage their health and wellness using digital tools—supported by connectivity with clinicians and provider teams—in a secure and private environment whenever and wherever care is needed. The DHI is the only comprehensive tool to assess and advise health system leaders on how to achieve outcomes using digital health, not just to use technologies or achieve other more specific measures. This blog series dives into each of the four dimensions of the DHI: governance and workforce, interoperability, predictive analytics, and person-enabled healthcare.

Interoperability is far more complex than just connecting devices within an organization.

Interoperability is defined as the ability of different information systems, devices and applications to access, exchange, integrate and cooperatively use data in a coordinated manner—within and across organizational, regional and national boundaries—to provide timely and seamless portability of information and optimize the health of individuals and populations globally. Health data exchange architectures, application interfaces and standards enable data to be accessed and shared appropriately and securely across the complete spectrum of care, within all applicable settings and with relevant stakeholders—including by the individual.

Simply stated, interoperability is required to make data portable and useful—particularly across the traditional boundaries of departments, organizations and geographies.

In the U.S., despite 80% of physicians using interoperable EHRs that generate structured documents, only 10% could find, send, receive and integrate patient summary records from outside their health system. To achieve a truly seamless, automated experience for users and improve outcomes, ensuring alignment across all interoperability subdimensions is crucial.

After multiple months of extensive review of literature on digital health, HIMSS defined the four dimensions of digital health as workforce and governance, interoperability, predictive analytics, and person-enabled health. HIMSS defines the four measurables or subdimensions of interoperability as follows:

Foundational Interoperability

Establishes the inter-connectivity requirements needed for one system or application to securely communicate data to and receive data from another. It is defined as the exchange of data at the individual level, which is accessible across clinical, social and community settings. Foundational features of interoperability include data and information capture; capacity for data storage and data management; access to data to inform communication between individuals and clinicians, teams and organizations; capacity for wireless and multimedia data exchange; and virtual/remote information exchange to communicate information.

Structural Interoperability

Defines the format, syntax and organization of data exchange, including at the data field level for interpretation. It describes the flow of data and information that is automated and integrated across multiple and varied sources of data, data reporting and access functions; data center structure; data integrity; and information exchange across multiple and varied platforms.

Semantic Interoperability

Provides for common underlying models and codification of data, including the use of data elements with standardized definitions from publicly available value sets and coding vocabularies, providing shared understanding and meaning to the user.

Organizational Interoperability

Includes governance, policy, social, legal and organizational considerations to facilitate the secure, seamless and timely communication and use of data both within and between organizations, entities and individuals. These features enable shared consent, trust and integrated end user processes and workflows. Examples include secure access to individual-level data, identity and access management; centralized authentication; firewall integration; web and email security; and cloud orchestration and coordination (both private and public cloud infrastructure). Organizational indicators also address quality of service and experience for users.

Interoperability, in essence, should be the digital infrastructure strategy that makes data accessible to stakeholders and ensures standardization, structure and semantics are helping make the seamless flow of information possible. Successfully mastering the interoperability dimension of the Digital Health Indicator (DHI) will allow your organization to execute and support a broader range of digital health objectives.

What are the challenges?

According to a report from EHR Intelligence 2019, only 37% of health systems surveyed could successfully share information with other health systems. Nearly half of all respondents agreed that interoperability challenges limit efforts to improve workflows and develop new models of care.

The constraint of cost remains constant, although many technologies support enabling technologies like APIs more than ever before.

Data transparency is key for digital health systems that want to continue thriving in the future, explained Anne Snowdon, RN, PhD, FAAN, director of clinical research, HIMSS.

“When you have high degrees of transparency, consumers are much more confident in their healthcare systems. A digital health system by necessity requires access to data and to tools that help patients understand what that data means, what the health education tools and technologies can offer, and how they can help them achieve their health goals.”

Often, the biggest challenge is involving more stakeholders to effect change. Advanced interoperability requires involvement and buy-in from clinical, legal, security and financial stakeholders—it’s not just an IT issue anymore.

What are some examples of healthcare organizations getting it right?

Duke Health has validated and revalidated at Stage 7 on three HIMSS Analytics maturity models: the Electronic Medical Record Adoption Model (EMRAM), the Outpatient Electronic Medical Record Adoption Model (O-EMRAM), and the Adoption Model for Advanced Analytics (AMAM).
Over the last decade, Duke Health replaced 135 systems and moved to a single-EHR platform, enabling interoperability across the entire health system. This helped coordinate and provide improved, safer patient care across Duke Health’s ambulatory and inpatient care environments. Tangible results the organization reports include savings (cost, time, resources); reduced medical errors; outcomes (patient quality and safety, financial, operational); and creative use of physical space formerly occupied by on-site files.

Parkland Health & Hospital System in Dallas leverages interoperability capabilities by extracting externally sourced data that helps identify and engage at-risk patients. The Parkland Center for Clinical Innovation, a health IT research and development think tank, launched the Dallas Information Exchange Portal, a local health information exchange, in 2015. It connects the hospital system to Dallas-based social services organizations—such as food pantries and homeless shelters—in an effort to help physicians and case managers streamline healthcare coordination among disadvantaged patients. Most healthcare data is reactive and historic; Parkland identifies patients with preexisting conditions, food insecurity or unsafe environments, then engages people in highly personalized ways to offer care and programs that are proactive and appropriate.

To provide the best care possible and drive improved outcomes, health systems need to prioritize social determinants of health by leveraging social and economic information about each individual. Healthbox can work with you to develop an innovative digital strategy for your organization and to identify solutions that meet your unique needs—empowering underserved communities and those most vulnerable to health challenges. | More on social determinants of health

What does a future with interoperability in healthcare look like?

Healthbox believes the ideal future of interoperability is one where patients own their data, granting targeted access to organizations they trust to help them be more proactive and predictive in their health and healthcare. Since data is easily transferred across organizations, individuals opt in or out of clinical studies and get paid for their participation—versus the current system, where patients typically sign away their rights and compensation opportunity.

Best practices would include:

-Security breaches and alerts are tracked using machine learning technology that helps identify accuracy and risk of alerts, manages the cost of a breach and tracks compliance with security legislation.

-Identities and access are properly managed between the entire care team and patients, allowing for secure messaging, consultations and real-time access to patient data that is securely managed to protect privacy.

-All individuals have access to their personal health records, health system services, educational tools and health navigation tools to support healthy decision-making and improve outcomes.

-Fully integrated virtual care and remote patient monitoring services are in regular practice, driving personalized insights that can lead to intervention.

-A unified, virtualized data center supports agility and necessary apps and APIs.

-Computer hardware and software with desktop-based, room-based and mobile-based endpoints support clinical and administrative workflows.

Above all, data infrastructure should be at the core of all leadership and strategy decisions. Once we can ensure that all individuals have access to the information they need to improve their health and the health of their patients—without added complexities—we will see the real transformation take place.

Healthbox, a HIMSS Solution and healthcare advisory firm, drives innovation from the inside and out, helping organizations build internal innovation programs, assess the potential of employee-led projects, and look to the market to find solutions to implement or invest in.

Identify your organization’s strengths and opportunities to inform a comprehensive digital health strategy with the complimentary HIMSS Digital Health Indicator  (DHI) Rapid Assessment.

For more information on interoperability, read the HIMSS guide to Interoperability in Healthcare.

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