Interoperability

In support of a paperless industry, the Australian Digital Health Agency (ADHA) has launched an initiative to enhance secure messaging functionality by 2020.  The initiative, a $30,000 boost to software vendors, aims to enable clinical software providers with the support necessary to adopt and integrate new secure messaging standards into existing clinical information and messaging systems.  All private vendors that currently operate a clinical information or secure messaging system with secure messaging capabilities at two different sites as a minimum are eligible for the funding. Eliminating paper-based messaging in healthcare has been a priority for the National Digital Health Strategy, which was approved in 2017 by all states and territories through the Council of Australian Governments (COAG) Health Council.  Since then, the ADHA has been working with software and healthcare providers to develop a set of standards that will improve the secure exchange of healthcare information.  A trial of the co-designed standards was run in 2018, overcoming what were then the two final hurdles to making different platforms interoperable: universal message formats and the ability to search multiple databases of healthcare providers. “The industry has agreed to the same interpretations and allowed their systems to display messages in a number of formats: RTF, PDF, CDA, and HL7 version 2,” ADHA Chief Operating Officer Bettina McMahon said previously. Being able to find the details of a healthcare provider was the other major hurdle, as different healthcare vendors maintain their own databases and a GP using a platform from one vendor often can’t find clinicians using a different one.  The set up of a distributed directory would allow clinicians with one vendor to be able to search all databases, according to McMahon.  Following the success of the trial, the agency is now encouraging widespread adoption. ADHA Chief Medical Adviser Clinical Professor Meredith Makeham said many healthcare professionals are already using secure messaging platforms; however, many of them are not compatible with one another, resulting in these professionals using fax machines or the post to send information to one another. “The inability of healthcare providers to share information quickly can lead to communication breakdown, which can contribute to poor health outcomes and unnecessary duplication of care,” Makeham said. “This is a significant step toward ensuring healthcare providers can use the tools they already have to send information to their patients and other clinicians providing those patients care, and in turn provide safer and more comprehensive care.” [Read more: Paving the way for interoperability in Australian healthcare | To fax or not to fax?] Consumers Health Forum of Australia Chief Executive Officer Leanne Wells said a modern, connected health system requires modern communication technologies and interoperability. “Manila folders of paper records and fax machines aren’t good enough in the 21st century – secure, robust and interoperable messaging is fundamental to creating the patient-centred health system Australia needs and deserves,” she said. General Practitioner and Advisor to the ADHA, Dr Nathan Pinskier said the initiative is an “important next step” on the path to mainstream adoption of secure electronic communications in healthcare. “Secure communications will provide more efficient, safer and direct transfer of clinical information between healthcare providers,” he said. “Numerous coroners’ reports have highlighted the risks of a continued reliance on legacy systems such as fax and post. It’s time for healthcare as an industry and profession to adopt 21st century communications solutions.” Vendors interested in the initiative can express their interest on ADHA’s website.

The HELP Committee on Tuesday heard feedback from stakeholders about how the proposed rules from CMS and ONC should be fine-tuned for optimal effect.

HIMSS has crafted a new definition for interoperability. HIMSS, the owner of Healthcare IT News, described the new concept as one specifically fit for the larger healthcare ecosystem. Senior Director of Informatics at HIMSS, Mari Greenberger, explained that there are now four layers to the proposed interoperability definition: foundational, structural, semantic and organisational. "This definition is an aspirational one," Greenberger said. "It's what HIMSS is trying to accomplish and work toward when it comes to achieving global interoperability. We added the additional level of ‘organisational’ to illustrate the critical need for a robust interoperability infrastructure as well as highlighting the non-technical considerations that play into successful interoperability. "HIMSS is trying to define interoperability and its various levels with an international perspective," she added. "We also worked to elevate the need for improved cross geographic jurisdictions/cross-border exchange." With that, here’s the full definition HIMSS proposed: Interoperability is the ability of different information systems, devices or applications to connect, in a coordinated manner, within and across organisational boundaries to access, exchange and cooperatively use data amongst stakeholders, with the goal of optimising the health of individuals and populations. Health data exchange architectures and standards allow relevant data to be shared effectively and securely across the complete spectrum of care, within all applicable settings and with relevant stakeholders (including with the person whose information is being shared). Optimally, interoperability facilitates connections and integrations across these systems to occur regardless of the data’s origin or destination or the applications employed, and ensures the data are usable and readily available to share without additional intervention by the end user. In the health ecosystem, interoperability furthers the goal of optimising health by providing seamless access to the right information needed to more comprehensively understand and address the health of individuals and populations. Systems participating in information exchange do so with varying degrees of interoperability. Each component, described below, demonstrates the types of exchange organisations may engage in and such exchanges may occur simultaneously within a single healthcare setting: Foundational interoperability develops the building blocks of information exchange between disparate systems by establishing the inter-connectivity requirements needed for one system or application to share data with and receive data from another. It does not outline the ability for the receiving information technology system to interpret the data without interventions from the end user or other technologies.   Structural interoperability defines the structure or format of data exchange (i.e., the message format standards) where there is uniform movement of healthcare data from one system to another such that the clinical or operational purpose and meaning of the data is preserved and unaltered. Structural interoperability defines the syntax of the data exchange. It ensures that data exchanges between information technology systems can be interpreted at the data field level.   Semantic interoperability is the ability of two or more systems to exchange information and to interpret and use that information.Semantic interoperability takes advantage of both the structuring of the data exchange and the codification of the data, including standard, publicly available vocabulary, so that the receiving information management systems can interpret the data. Semantic interoperability supports the electronic exchange of patient data and information among authorised parties via potentially disparate health information and technology systems and products to improve quality, costs, safety, efficiency, experience and efficacy of healthcare delivery.   Organisational interoperability encompasses the technical components as well as clear policy, social and organisational components. These components facilitate the secure, seamless and timely communication and use of data within and between organisations and individuals. Inclusion of these non-technical considerations enables interoperability that is integrated into end-user processes and workflows in a manner that supports efficiencies, relationships and overall health and wellness through cooperative use of shared data both across and within organisational boundaries. HIMSS is seeking feedback, so interested parties can comment here until March 23, 2019.

The health system co-designed a platform that provides multifactorial data analysis and direct-to-physician communication, as well as continuing education material.

Agreeing to the same format for demographic data would boost patient safety, according to research from Indiana University and Pew.

Shaping the future of healthcare IT requires an understanding of common problems and solving them in a whole health economy – inside and outside of the hospital, says Mike Fuller, regional managing director at InterSystems.

Association says the update is more global in scope and fit specifically for the healthcare ecosystem. 

Joyce Sensmeier, vice president of informatics at HIMSS, says tools exist to engage patients with their data in ways that create a good relationship with providers — when the technology doesn't get in the way.

HIMSS CEO Hal Wolf discusses with a panel of luminaries in the field of healthcare the interoperability rule that gives people full access to their clinical records.

A price transparency service allows providers to make choices that are in the clinical and economic best interests of the patient, says Andrew Mellin, VP and medical informatics physician at Surescripts.