Health data interoperability, a buzzword in the last decade, is critical for digital health transformation. According to HIMMS, it involves various systems, devices, and apps securely sharing and using data across boundaries to enhance global healthcare. Interoperability benefits include improved patient care coordination and reduced administrative burdens. It comprises four stages: foundational, structural, semantic, and organizational interoperability. Foundational is basic data exchange, while structural defines data format. Semantic ensures shared meanings through coding, and organization involves governance and policy. Achieving these levels prepares healthcare for future digital advancements.
Over the past decade, the term “health data interoperability” has gained significant attention within the healthcare industry, and its importance in driving digital health transformation cannot be emphasized enough.
According to the Healthcare Information and Management Systems Society (HIMMS), health data interoperability is defined as the “ability of various information systems, devices, and applications to securely access, exchange, integrate, and collaboratively utilize data in a coordinated manner, spanning organizational, regional, and national boundaries, to facilitate timely and seamless data transfer to enhance the health of individuals and populations worldwide.”
The advantages of healthcare interoperability encompass improved patient care coordination and reduced administrative burdens for healthcare payers and providers. Additionally, interoperability plays a crucial role in supporting public health surveillance and initiatives focused on population health.
Healthcare institutions can achieve interoperability at different levels, which HIMMS categorizes into four stages: foundational, structural, semantic, and organizational.
Foundational Interoperability:
Foundational interoperability serves as the initial building block, establishing the essential requirements for one system or application to securely transmit data to another. In this level of interoperability, the receiving system does not need to interpret the exchanged data but only acknowledge its receipt. For instance, sharing a PDF document summarizing a patient’s hospital stay and discharge medication list with another system falls under foundational interoperability. However, the receiving system cannot automatically process this data further, requiring manual input by a healthcare provider. While foundational interoperability is vital, it alone does not enable meaningful use of health data.
Structural Interoperability:
Structural interoperability builds upon foundational interoperability by defining the format, syntax, and organization of data exchange. It relies on message format standards to ensure that health data can be exchanged between systems while preserving its meaning. For example, ePrescribing relies on structural interoperability, as both the provider’s and pharmacy’s systems must adhere to the same data standards for accurate prescription information exchange. One widely adopted standard for structural interoperability is HL7 Fast Healthcare Interoperability Resources (FHIR), which assigns standardized identifiers to discrete data elements, facilitating data sharing.
Semantic Interoperability:
Semantic interoperability involves the use of common underlying models and standardized data coding, including publicly available value sets and coding vocabularies. This ensures that data can be exchanged accurately with a common format and shared meaning. Clinical terminologies like SNOMED CT, ICD, and LOINC play a crucial role in achieving semantic interoperability. With semantic interoperability, healthcare providers can exchange patient data while ensuring a shared understanding of medical terminology, which can lead to reduced duplicate testing, enhanced clinical decision support, and improved care coordination.
Organizational Interoperability:
Organizational interoperability encompasses governance, policy, social, legal, and organizational considerations required to facilitate secure, seamless, and timely data communication within and between healthcare organizations, entities, and individuals. Achieving this form of interoperability involves addressing non-technical aspects, such as policy development and legal compliance. Some healthcare organizations pursue organizational interoperability through health data utilities (HDUs), which are statewide entities designed to enhance electronic health data exchange for various purposes, including treatment, care coordination, and quality improvement. HDUs emphasize multistakeholder governance and typically operate as non-profit organizations or state agencies, leveraging existing data exchange infrastructure.
While the ultimate goal is organizational interoperability, many healthcare institutions are still working to establish foundational and structural interoperability. However, adopting health data standards to achieve lower levels of interoperability is a critical step in preparing healthcare organizations for future advancements in health data exchange as the digital health transformation continues to evolve.
