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Interoperability is a data superhighway, but most healthcare stakeholders are still stuck in a parking lot. Learn more about the latest strategies, system designs, and use cases to advance towards achieving 100% interoperability in healthcare.

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Published by Ashley Stone, 2019-11-18 06:19:51

Interoperability eBook

Interoperability is a data superhighway, but most healthcare stakeholders are still stuck in a parking lot. Learn more about the latest strategies, system designs, and use cases to advance towards achieving 100% interoperability in healthcare.

Keywords: Interoperability

INTEROPERABILITY

POWERINGTHEIDEAOF
INTEGRATEDCARE

Index 1
2
1. Introduction 4
2. UnderstandingInteroperability 6
3. TheAimsandMeansofInteroperability 7
4. TypesofInteroperability 8
5. MappingofInteroperabilityStandards
6. HowCanClinicalDataBeMadeMeaningfuland 10
12
Usable? 14
7. TheCuriousCaseofHealthDataExchange 15
8. WebAPIs 17
9. HL7FHIR 19
10. SMARTonFHIR 22
11. Pushvs.PullModelsofExchange
12. SemanticInteroperability
13. Conclusion

1.Introduction

ImagineapatientisadmittedintheICUanywhereinthecountry.Multipledevicesareconnected
tothatsinglepatient,andeachdeviceisgeneratingavastamountofdataeveryfewseconds.
Thishealthcaredataislockedindatasilos,controlledbydifferentstakeholders.Therealityis
manyofthem arereluctanttosharethisinformationwithothers.

1 www.osplabs.com

2.UnderstandingInteroperability

Thelackofdatainteroperabilityhasplaguedhealthcareformanyyears;itisresponsiblefor
drivinguphealthcarecostsandnegativelyaffectingyourhealthuntilnow.

Tounderstandinteroperability,wemustfindanswerstothefollowingquestions:

•Whathappenstothecollectedhealthdata?
•Howdoesittravelfrom onesystem toanotherintheenterprise?
•Whocanaccessthedataandhoweasilyitcanbeaccessed?
•Howwellisthedatalinkedtootherdataofasinglepatient?
•Howwellisthisdatalinkedtootherdataofsimilarpatientsinthesame

healthcarefacility?

•Candataofasinglepatientbeleveragedforafull-scalepopulationhealth

managementsystem?

MillionsofpatientsinhealthcaresettingsacrosstheUSgenerateavastamountofhealthdata.
Patientsservedbyradiology,oncology,cardiology,andotherdepartments,allconnectedto
multipledevicesgeneratingsheervolumesofdata.

2 www.osplabs.com

Today’shealthITchallengesnotonlyaffecttheprovidersbutallhealthcarestakeholders.Hereare
somechallengesthatwearefacingtoday,

• 31%ofsurveyedhealthcentersreportdatasecuritybreaches.

• Careteamsarenotabletocollaboratewithpatientsandtheirfamiliesbecausetheycannotview

thesameEHR.

• Majoramountofdataremainsmissing,inaccurate,andnon-standardized.

• Theneedlessduplicationoftests,medications,andtreatmentsaddstorisinghealthcarecosts.

• Systemscannotintegratedatafrom differentsources—eventhosefrom withinthesame

organization.

• Healthinformationanalysisandrelatedresearchareobstructedbylackofclinicaldata

warehouses;onlyclinicaldata“silos”exist.

Thepressureofthesemajorchallengesonhealthcaresystemshasneverbeenhigher.Thisisdue
torisingexpectations,agingpopulations,andespeciallyinemergingeconomies,thecombined
challengesofinfectiousdiseaseandtherisingincidenceofchronicillness.

3 www.osplabs.com

3.TheAimsandMeansofInteroperability

InSanDiego,whereIlive,wehavehealthsystemsthathaveno
businesscaseforexchangingdata,butmorethanthat,wehavebig
healthcaresystemswheredatafrom theemergencyroom can'tbesharedwith
acutecareunitinthehospital.That'snotaninteroperabilityproblem,that'sa
problem ofthewaysystemsevolveandthebusinessneedsofour
respectivestakeholders.There'snotthewilltoovercomethechallenges,nor

apparentlythecapabilitiestodoso.
— CharlesJaffe,CEO,HL7

4 www.osplabs.com

5 www.osplabs.com

4.TypesofInteroperability

Interoperabilityhelpstomaketherightdataavailabletotherightpeopleattherighttimeacross
theorganization.TheinteroperablehealthITecosystem canberelieduponandmeaningfullyused
byrecipients.
Anenterprise-widehealthcareinteroperabilitystrategyisneededtoensurethemeaningfuland
appropriateuseofinsight-richdata,helpingtotransform healthcaredeliveryforeveryone.

ExistingInteroperabilityStandardsandOrganizations

Standards

Organisations

6 www.osplabs.com

5.MappingofInteroperabilityStandards

Insummary,thereisnosingleorganizationthatcoversallthestandardsneededforDigitalHealth.
However,standardscanbecombinedtoprovideafullyinteroperableDigitalHealthservice.

7 www.osplabs.com

6.HowCanClinicalDataBeMadeMeaningful
andUsable?

InformationtechnologyisrapidlyadvancingwithimmensegrowthintheHealthITmarketplacein
thebackground.IthasbroughtarushofhealthITorganizationsintothefield,addingtothesheer
volumeandawidevarietyofclinicalinformationoriginatingwithdifferentsystems.Theon-
slaughtofstructuredandunstructureddataaddstothechallengeofdeliveringacomprehensive
andintegratedviewofpatientcarethroughenterprise-wideinteroperability.
Clinicalinformationshouldbeeasytosearch,retrieve,andinterpretforanygivenuser’sneeds.It
ismadepossiblebyaddingmetadatatagsinDICOM toprovideacontext.Ourprimarygoalisto
makeinteroperabilityanongoingjourneywithmanyroutesbywhichitcanbeeasilyreached.

WhataretheMajorTechnicalChallenges&SolutionsforDelivering
MeaningfulInformation?

Seamlessdeliveryofmeaningfulclinicalinformationacrosstheenterpriseisessential.Itrequires
advancedanalogousmethodsandtoolsforeffectiveimagecapture,processworkflowmanage-
ment,imagedatamanagement,centralizedstoragesystem,andtheabilitytoaccessandshare
datathroughouttheenterprise.

8 www.osplabs.com

Severalchallengesmustbesolvedtobuildafullyintegrated
enterpriseecosystem,including:

Disparate Acquisition Acquisition
Images Devices

DataFormats& Metadata Storage
Protocols

Solutions:

Acquisitionand DataFormats& EnterpriseData
Capture Protocols Recovery

Cross-enterprise • EHR
DataDiscovery Integration

9
Patient

DDaetmaoD•gisrcaopvheicry

www.osp•labs.com

7.TheCuriousCaseofHealthDataExchange

Since1987,HL7Internationalhasbeenworkingonhealthcaredatastandardstocreateand
improvethestandardsinusethroughoutthehealthcareindustry.HL7standardsareessentialfor
providerstointegratedatafrom differentvendors.
Differentsystemshavevariedworkflowswhicharesupposedtoworkwellinapatientfacilityor
anambulatoryenvironment.Thetechnologyleveragedshouldbeflexibleandeasilyconfigurable.
Let'sunderstandthetraditionalhealthdataexchangepatternusingHL7V2.

1.TraditionalDataExchange

• AdoctortypesdataintotheEHR.
• DataleavestheEHRinanHL7v2orCDAformatdocument.
• Thedataissentoveraninterfacetothereceivinghealthsystem.
• Thereceivinghealthsystem parsesthedataandimportsitintotheirdatabase.

TypicalPointtoPoint

10 www.osplabs.com

2.DataExchangewithanIntegrationEngine

Today,mostproviderspreferanintegrationengineatthecoreofalltheirinterfaces.Integration
enginesarequickandsimplifytheworkflow forcentralmonitoring,flow control,alerting,data
mapping,andmore,toorganizedataflowwithintheseapplications.

Interoperabilitymeanstheabilityofhealthinformation
systemstoworktogetherwithinandacrossorganizational
boundariesinordertoadvancethehealthstatusof,andthe

effectivedeliveryofhealthcarefor,individualsand
communities.

-InteroperabilityDefinitionbyHIMSS

11 www.osplabs.com

8.WebAPIs

AnAPI,orapplicationprogramminginterfacetoenablecommunicationbetweenmultiplehealth
systemssuchasEHRs,mobileapps,IoTdevices,etc.APIsplayavitalroleforanyauthorized
applicationtoreceiveand/orsenddatawithstringentsecurityauthentication.

MajorAPIUsageCategories:

1.APIsforthetraditionalproviderintegrationstrategy
2.OpenAPIforclinicaldatasharing

1.APIsforProviderIntegration

APIscansupplementthecurrentmethodsofHL7v2exchangebyofferingacheaper,lighter,and
easierformatofinteroperability.ProviderscancreatearobustAPItofacilitateexternal
data-sharingrequestsbysimplysharingtheirapprovedAPIstandards.

12 www.osplabs.com

2.OpenAPIforSharingClinicalData

AggregationofmedicalhistoryofasinglepatientispossiblewitheasyaccesstodataviaanAPI.
Toprovideapatient’scompleteclinicalinformationviaAPI,providersmustcombinedataand
returnittotherequestingapplicationviaAPI.Theintegrationlayercanhelphealthorganizations
tobreakfreefrom EHRdatasilosandgaintotalcontrolofpatient'smedicaldata.

13 www.osplabs.com

9.HL7FHIR

Aswehavelearntabove,HL7v2isawell-establishedstandardthathelpstoconnectenterprise
applications.LeveragingHL7V2alsohasmanychallenges.It'slimitedtomoderndevicesand
appswhicharetryingtoleverageavailableclinicalinformationofapatient.Implementingdata
privacyandsecurityarealsoamongthepressingchallenges.
TheFHIRstandardhasanAPIdesignedwithamoreflexibleandlightweightmethodofclinical
dataexchange.FHIRutilizesRESTfulwebservicesalongwithSOAPwebservices,making
securityeasiertomaintain.
Webserviceshavereadilydefinedsecurityprotocols(HTTPS)andcommonlyusedauthentication
techniqueslikeOAuth2.0.SecuritymeasuresimplementationbecomeseasierwithFHIRwith
flexibilitytoleveragewidelyusedsecuritystandards.CombiningtheFHIRAPIwithmultiple
advancedwebservicesisthefutureoftechnology.

14 www.osplabs.com

10.SMARTonFHIR

SMARTisanacronym for'SubstitutableMedicalApplicationsandReusableTechnologies'.Itwas
createdin2010andimplementedattheHarvardMedicalSchoolDepartmentofBiomedical
InformaticsandBostonChildren’sHospitalComputationalHealthInformaticsProgram.

'SMARTonFHIR'isasetofopenspecificationstointegrateappswithEHRs,healthportals,HIE
(HealthInformationExchange),andotherHealthITsystems.

SMARTwasstartedwithanobjectivetodefineadatastandardwhichwouldmakea“buildonce,
goanywhere”modelpossible.SMARTisastandardthatworksinassociationwithandontopof
FHIR.Thisiswhyhealthtechindustrycommonlyrefertoitas'SMARTonFHIR'.

SMARTfocusesonformalizingthemethodforinteractingwithFHIRinterfaces,outlininghowthe
mobileappswillbe'launched'from theEHR.SMARTalsofocusesonstandardizingthesecurity
protocolsusedbythird-partiestoexchangedataintoEHRsystems.

SMARTfollowsadedicatedapproachtoproduce'how-todocumentation'designedtohelp
developerstounderstandwhatFHIRmakesavailableandhow tobuildalongsideSMARTfor
futurerolloutstoalivehealthcaresetting.

ThegoalofSMARTisaudaciousandcanbeexpressed
concisely:aninnovativeappdevelopercanwriteanapp
once,andexpectthatitwillrunanywhereinthehealthcare

system.Further,thatappshouldbereadily
substitutableforanother.

-KennethMandl,MD,MPH
Chair,SMARTAdvisoryCommittee

15 www.osplabs.com

HowtoimplementaSMARTonFHIRapp?
Theprocessofimplementationhappensinthefollowingsteps:

1. Therequiredspecificationisdeveloped.
2. EHRvendorsimplementthestandardsaswellasspecifications.
3. ThehealthsystemsEHRconsumersinstall,update,andconfiguretheirsystemsto

consolidatethestandards.
4. Applicationsaredevelopedontopofthehealthsystem’sspecifications.
SMARTstrivedtoproducespecificationsthatworkformodern-dayhealthcareappdevelopers
andareimplementablewithintoday’sevolvingtechnologylandscape.SMARTonFHIRaddresses
theneedsofend-usersandappdeveloperswhileprovidinganopen-standards-basedplatform
thatalignswiththeneedsofclinicalsystem vendors.Tobuilduponthemomentum,we
recommendastrongpushtowardearlyplatform adoptioninserviceofbusinesscasesthat
providevaluetoday.

16 www.osplabs.com

11.Pushvs.PullModelsofExchange

APIsallowapplicationstopulltheinformationitneedsfrom whenitisneeded.Witheachupdate
intheapplication,thetraditionalV2interfacescontinuallypushthepatientdata.Rather,aspecific
pieceofclinicaldatasuchasorderstatus,currentbloodpressure,location,etc.shouldbe
receivedinreal-time.Real-timeapproachisnotpossiblewithv2.

AHybridApproachtoDataExchange

83%ofhealthcareprovidersusesomecloudserviceorapplicationwithintheirITarchitecture-
accordingtotheHIMSSAnalyticsCloudSurvey.
IfwedecidetofollowthegroundbreakingFHIRAPIapproachtodataexchange,werequireanex-
tremelyflexibleapproachtomanagehealthdata.ModernhealthITdepartmentsneedacentral
commandtohelpguidetheflow ofdatabetweensystemstoensurethateachapplicationand
healthcareproviderhastherightpatientdata,attherighttime,withtherightinsights.
AsFHIRAPIconnectivitybecomescommon,thetransparencyofEHRdatabaseswillsurely
increase.Externalapplicationsforpatientsandproviderswillhavetheabilitytoimportandexport
clinicaldatamoreeasilywithouttheneedforproviderstodirectlygiveaccesstotheEHR
database.Thischangewilllikelycauseafundamentalshiftawayfrom dependenceonEHR
functionality.

17 www.osplabs.com

HybridIntegrationDataflowusingCorepointIntegrationEngine:

18 www.osplabs.com

12.SemanticInteroperability

Tomovetowardsamoreholisticmulti-platform,multi-networkapproachSemanticInteroperabili-
tycanplayavitalrole.Today'smobileoperatorsareworkingwithhealthcarepartnerstodeliver
value-addedDigitalHealthservicesinfivemainareas:

•DataHosting,ManagementandSupport/CloudServices

Multiple health devices taking keyreadings with a centralized data storage,usuallyin a
cloud-basedEHRrequireapowerfulinteroperablesystem.The dataalsoneedstobepresented
backtocreateinsightforpatientsandhealthcareprofessionals.

19 www.osplabs.com

•HospitalInformation&CommunicationSystems

SystemsthathelphealthcareprofessionalstoaccesstheirpatientsDigitalHealthrecords
wherevertheyareinthehospital.

•PatientRelationshipManagement&CustomerCare

Servicescanrangefrom medicalappointmentremindersthroughSMStocallcenters,to assist
healthcareprovidersinpatientengagement.

20 www.osplabs.com

•ContentServices,HealthAccess,andMonitoringSolutions

Providingnecessaryguidancetoindividualsfortheself-managementandprevention of their
healthconditions.

•ConsumerDeviceManagement&Supply

Fitnessdevicesorsmartwatches,enablingindividualstomanagetheirownhealthandwellness.

21 www.osplabs.com

13.Conclusion

Lackofinteroperabilityisoneofthegreatestchallengestoachievingimprovementstohealthcare
andcostefficiencypromisedbyemerginge-healthsystems.Ontheotherhand,implementingthe
currentstandardsforinteroperabilityisalsohard.Butaninteroperablehealthcareecosystem
offersgreatopportunitiestopositivelyinfluencepatientsandprovidersthroughhighlyintegrated
caredeliverymodels.
Healthcareorganizationsshouldlookholisticallyatadvancedandsecuredatasharingstrategies
thatspantheentirepatientcarecontinuum.Healthcaretechnologydevelopersshouldseekinput
andcollaborationwithfederalagenciestoinform governanceimplementationandensurebroad
participationacrossexistingoperatinghealthinformationnetworks,includingthosefocusedat
thevendor,enterprise,regional,andstatelevels.
Thefutureofhealthcaredeliverywillbeaboutdemystifyingtheconcepts,connectingthedots,
eliminatingdisconnects,sharingdataalongthevaluechaintounderstanditasawhole.Interoper-
abilityofdatatosupportthefruitfulcollaborationofallthemajorhealthcarestakeholderswillbe
key.

22 www.osplabs.com

Wearealeadingsoftwaredevelopmentcompanyaimingtoempower,and
inspiretheworldwithnext-gensolutions.Wehelpinsimplifingeverystepof

thedevelopmentprocess,from system architecturedesigntoquality
delivery.Ourintelligentprocessesenablequickdeploymentof

enterprise-gradesolutionsagainstthetoughest,andmostcomplex
challenges.

Wearere-imagininghowtechnologycanempower
Healthcare,AI,Analytics,andFinancialorganizationstobuildsolutionsfor

everydayuseinbusinessapplications.
With10+yearsofexperience,and200+customersworldwide,we're

leveragingtechnologytobuildthefuturetoday.

www.osplabs.com

DiscussYourProject

[email protected] osplabs.com

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