A great deal of industry conversation surrounding interoperability is about the EHR, standardizing CCDs, improving record-sharing abilities to and from organizations, and translating records between one EHR brand to another.
However, the EHR is just one piece of the puzzle. In fact, as an industry, we have — for the most part — figured out how to overcome the technical hurdles of CCD compatibility, as well as other barriers to getting records in and out of different systems. The real challenges of interoperability exist at a higher level.
With the challenges of interoperability having already been largely resolved at a technical level, it’s time to examine interoperability in the context of layers in order to achieve seamless integration at a higher level.
Interoperability is less about technical connections and more about operational, political, and philosophical differences that are much thornier to deal with, which is ultimately what we need to be focusing on. While it’s true that EHRs are a key piece of the interoperability puzzle for hospitals and health systems, there are three distinct layers within the healthcare industry that highlight the less technical barriers to interoperability.
1. The first interoperability layer to examine is the organizational level of healthcare, which impacts the exchange of information within the existing systems. (e.g. medical records, administrative systems, billing systems, as well as medical and operational IT systems).
These many and differing organizational functions within a hospital have their own ecosystems of software which all speak varying languages — and not just the language of data exchange but also the languages of: accounting vs. radiology, or admissions and discharges. The challenges associated with these information sources are less of a technical barrier, and rather one of semantic and operational perspective.
2. The second layer is the community and regional level of healthcare, where the complexity of interoperability becomes even more elaborate. Here, the exchange of information is not limited to individual organizations but extended between different organizations (e.g. data sharing among health systems and pharmacies, public health organizations, radiology and labs, payers and researchers), which can create all sorts of complications.
At this level you have HIEs, national registries, NIH/CDC (collecting epidemiological data), alliances like GPOs and BPOs, payers, pharma, and research organizations — all of which have different purposes, motivations, perspectives, and platforms. With so many different entities each with their own priorities, permissions, and requirements, the interoperability challenges become extremely complex not just technically, but politically and operationally as well.
3. Finally, the device level (Internet of Medical Things) of healthcare can further complicate information exchange. The growing number of hardware platforms, operating systems, and communications protocols employed by the myriad of connected health and healthcare devices — from “smart” consumer products to personal fitness apps to sophisticated implantable medical devices — is staggering.
The task of accessing, aggregating, and normalizing that data into comprehensive and accurate data usable at the point of care is becoming increasingly difficult. As the industry continues to sort out this challenge at the micro level, the impacts may be felt at the organizational and community levels as well.
As it stands now, most technical concerns associated with interoperability have solutions, and as such the industry must shift its focus to higher-level issues that stand in its way. It is unrealistic to expect every organization, system, or device to operate with the exact same communication protocols, which is why it’s necessary for organizations and health systems to think beyond the EHR to implement a seamless interoperability layer tying together the many technologies and tools an organization might have in place.
An interoperability layer like Rhapsody or Corepoint helps bridge the gaps created by these differing technologies and platforms, allowing organizations to focus on the higher-level, operational, and political aspects of interoperability. These issues include transforming organizational behavior and shifting industry perception about its responsibility toward patients, clinicians, members, and other stakeholders.