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
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