Interoperability: It All Comes Down to Semantics

Read these excerpts from our latest issue of the Inside Edge or jump straight to the entire issue [LOGIN TO SEE LINK].

Interoperability: a career-long challenge

in healthcare is a two-fold problem: lack of requirements and standards for semantic interoperability and lack of a universal patient identifier. “We need those two things,” says Michael Shabot, MD, EVP and System Chief Clinical Officer, Memorial Hermann, “because the plugs, wires, Ethernet, HL7, FHIR, APIs and other technologies are not enough.”


Architecting interoperability at Ascension

If there’s a health system that needs data interoperability it’s Ascension. With 2,600 sites of care — including 153 hospitals and more than 50 senior living facilities across 22 states and the District of Columbia — St. Louis-based Ascension is the largest U.S. non-profit health system and the world’s largest Catholic health system. “Resources and workload balancing is key. In our journey at Ascension we decided to take a holistic approach to interoperability to help to mitigate these challenges and reduce the duplicate and competing workloads across the organization.”


Heading toward a network of networks

Achieving interoperability is not an “either/or.” It requires both connecting EHRs to each other and adopting and deploying standards. “Standards allow us to exchange clinical data in a reliable, repeatable manner,” says Gresham. ”Interoperability implies people crossing multiple networks. Facilitating that freedom means establishing network connectivity rather than point-to-point connections. Standards, deployed by organizations like CommonWell, support this ‘network of networks’ concept, which is the only way to scale interoperability.”


Messenger from the future

“All of healthcare’s problems are tied back to operational workflow inefficiencies. The COO is the most critical title in healthcare because hospital operations and decisions on how to run the business will be healthcare’s crucible. Also, the CIO and CMIO need to do a better job of mapping out processes. It’s more than technology and operations that leads to lack of interoperability.”


Follow the patient

Eleven years ago Epic first released Care Everywhere, its platform for connecting disparate EHRs. Today all of Epic’s customers are live with Care Everywhere and exchange 3.5 million patient records a day with 43 percent of that exchange happening with other vendors’ EHRs. “It’s grown very fast,” he says.


Internal Interoperability

Eardley focuses most of his effort on internal interoperability. “We’re trying to have—not so much an EHR—but an ecosystem of partners. The same foundational information is in the EHR, but we want to be quick, agile and cost effective. That means using APIs, FHIR, SMART on FHIR, all geared toward having more interaction with data in the EHR,” he says.


Docs — continue to — want interoperability

Deloitte’s 2018 Survey of U.S. Physicians* found that 62 percent of doctors believe that interoperability needs improvement, the survey’s highest-ranked issue. [see Fig. 1, below]. Importantly, the dial had not moved at all in two years: in Deloitte’s 2016 Survey of Physicians interoperability was the highest-ranked issue also at 62 percent.


“Market dynamics may be more favorable than in the past: Standards, such as FHIR (Fast Healthcare Interoperability Resources), have matured; several consumer technology companies are making serious plays in the healthcare field in general and in the EHR space in particular and there are signs of growing consumer demand for centralized access to their own medical information.”

Welcome disruptors?

Amazon, Google, IBM, Microsoft, Oracle and Salesforce recently issued a joint statement pushing for better interoperability in healthcare, especially by using cloud-based technologies and AI. “Open standards, open specifications, and open source tools are essential to facilitate frictionless data exchange,” according to the statement. “This requires a variety of technical strategies and ongoing collaboration for the industry to converge and embrace emerging standards for healthcare data interoperability, such as HL7 FHIR and the Argonaut Project.”