Sharing patient records outside of your health care organization can be challenging and prone to security risks. But interoperability, especially in EHR software or EMR software, can help alleviate your frustration.

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What This Article Covers

• What Is Interoperability?
  • Four Levels of Interoperability
  • Health Information Exchange and Data Sharing
• Primary Benefits
• Standards
• Implementation Guides and Profiles
• The Ecosystem
• Information Exchange Uses
• Organizational Considerations and Guidance
• Policies and Initiatives
• Assessing EHR/EMR Systems Interoperability Capabilities
• Next Steps

What Is Interoperability?

Interoperability is an essential aspect of modern technology that allows diverse systems and electronic devices to communicate and work together seamlessly.

The ultimate goal of interoperability is to ensure that different technologies, applications and digital platforms can collaborate to achieve a common objective without any data loss or misplacement.

Simply put, interoperability enables secure medical information exchange among health care providers. It allows multiple computer networks and systems to interact with each other and effectively share information, including patient health records and medical files.

In health care, interoperability facilitates secure patient health information exchange among providers, patients and third-party specialists. It reduces potential errors to enhance care coordination and treatment outcomes.

Interoperability helps you ensure patients receive the best possible care at reduced costs while increasing operational efficiency.

Levels

There are different levels of interoperability that health care organizations can achieve, each with its own set of benefits and challenges.

In this section, we’ll explore the four levels of interoperability and how they can help you improve patient care coordination, streamline administrative tasks and achieve greater operational efficiency.

Level 1: Foundational

Foundational is the most basic level of interoperability and enables two systems to communicate and exchange information in a common format. At this level, the focus is on establishing a basic connection between the systems and ensuring correct and secure data transmission.

Level 2: Structural

Structural involves the ability of two systems to understand the data exchange structure, format and syntax for seamless interpretation. It defines the standard format for both systems to have a common understanding.

Level 3: Semantic

The semantic level offers data codification and common fundamental models, including standardized definitions and data elements from publicly accessible value sets and coding lexicons, to help systems have a common understanding of the data’s meaning.

Level 4: Organizational

The organizational level incorporates governance, policies, and legal and organizational factors to promote secure and prompt collaboration and data use among physicians and medical entities. This is important to facilitate shared consent and integrated end-user workflows.

Health Information Exchange and Data Sharing

Health information exchange is the electronic medical data exchange among different health care organizations, such as hospitals, clinics and laboratories. It provides physicians with direct access to patient information, including medication lists, lab test results and other important data, to improve care quality and health outcomes.

Its primary focus is to retain data meaning during information exchange to reduce medical error risks, such as prescribing medications where negative interactions can lead to medical test duplications.

Information exchange in the European Union is commonly known as data sharing. The European Commission’s Support Centre uses this term to indicate practices, technologies, cultural elements and legal frameworks involved in information-based digital transactions across various organizations.

Although this term is broadly applicable to all types of data sharing, it’s commonly used for the health care industry or health-related data.

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Primary Benefits

When it comes to EHRs and EMRs, the interoperability benefits are numerous and significant. By investing in systems that support interoperability, health care organizations can improve patient care, maximize incentive earnings and enhance operational efficiency.

As the health care industry continues to evolve, interoperability is likely to become increasingly important, leaving organizations that prioritize interoperability better positioned to succeed in the digital age.

As per a recent study published by the Journal of Medical Internet Research, organizations using interoperable EHR systems were more likely to report that their EHRs had a positive impact on patient care, including improvements in medication safety, cost savings and patient outcomes.

Some top benefits of using interoperable EHR and EMR systems are mentioned below.

Improve Patient Safety

Enable health care providers to access comprehensive and up-to-date patient data to reduce errors and improve patient safety. Exchanging patient records stored in interoperable EHRs internally or with third parties can reduce discrepancies and inaccuracies associated with physical or verbal transfers.

Enhance Care Coordination

Let different care providers share patient information seamlessly to streamline care coordination and improve patient outcomes.

When care providers have access to a patient’s complete medical history, they can make data-driven treatment decisions resulting in improved clinical outcomes.

Interoperability can also help reduce the risk of medical errors, such as duplicative tests or procedures, which can lead to unnecessary costs and harm to patients.

Save Costs

By providing a secure and efficient means of sharing patient information, interoperable EHR/EMR systems can help your organization avoid costly fines and legal penalties associated with non-compliance.

Standards

Standards development organizations (SDOs)or standards setting organizations are non-profit organizations that develop and promote standards for various industries and sectors.

These organizations are responsible for creating guidelines, technical specifications and best practices to ensure quality and consistency in products, services and processes.

They play an essential role in promoting interoperability and standardization, which are essential for facilitating communication and collaboration across different organizations, systems and technologies.

These organizations consist of subject matter experts, industry leaders and other stakeholders who collaborate to develop and refine standards in their respective fields. They may be funded through membership fees, government grants or other sources of revenue.

Some of the most well-known health IT arena organizations include Systematized Nomenclature of Medicine International and the Clinical Data Interchange Standards Consortium.

Types of Standards

Medical entities use these standards as a common framework for quality, safety and efficiency. These standards help reduce costs, increase productivity and improve overall performance to benefit businesses, consumers and society as a whole.

Let’s look at these standards.

Vocabulary/Terminology

Vocabulary standards aim to ensure clear concept representation among parties to facilitate effective communication. Health information systems require structured terminologies, code sets and classification systems to communicate effectively with one another when sharing health-related data.

Several widely used vocabulary standards in health care include:

• Current Procedural Terminology (CPT)
• Healthcare Common Procedure Coding System (HCPCS)
• International Classification of Diseases (ICD-11)
• Logical Observation Identifiers Names and Codes (LOINC)
• National Drug Code (NDC)
• RadLex
• RxNorm
• Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT)
• Vaccines Administered (CVX)
• Manufacturers of Vaccines (MVX)
• The Unified Code for Units of Measure

Content

These standards relate to the information the two parties exchange. They define the content structure and include definitions for specific data or message types. examples include

• Consolidated CDA (C-CDA)
• HL7

Transport

Transportation standards focus on how computer systems exchange health information, including message formats, document structure, clinical templates, user interfaces and patient data merging. These standards revolve around two methods of information exchange, namely push and pull.

Examples of transport standards are given below.

• Digital Imaging and Communications in Medicine (DICOM)
• Direct Standard™
• Fast Healthcare Interoperability Resources (FHIR)
• Integrating the Healthcare Exchange (IHE)
• Continua Design Guidelines

Privacy and Security

These standards safeguard an individual or organization’s right to control the collection, access, usage or disclosure of their personal health information. The standards help determine who collects which information, when and for what purposes.

Additionally, security standards outline the administrative, technical and physical measures required to ensure the complete confidentiality and integrity of patients’ health information.

Privacy and security standards in the U.S. and Europe are common knowledge.

• HIPAA (Health Insurance Portability and Accountability Act of 1996) Privacy Rule
• HIPAA Security Rule
• GDPR (General Data Protection Regulation)

Identifier

Healthcare entities assign unique identifiers to providers and patients.

• Medical Record Number
• National Provider ID

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Implementation Guides and Profiles

Implementation guides offer a specific way to apply a standard in a particular health care scenario, ensuring consistency and removing ambiguity. They provide precise definitions for meeting clinical needs and a clear implementation path reviewed and supported by industry partners.

The use of implementation guides, such as IHE Profiles, provides a common language for discussing integration needs and capabilities, reduces complexity and cost, and alleviates implementation anxiety for purchasers and market suppliers.

Testing and Compliance

Adopting and implementing standards for health IT interoperability requires a comprehensive testing system that covers all stages of the process, from standards development to implementation and real-world feedback.

This testing ecosystem supports ongoing improvements to the development process. Mentioned below are some testing efforts that support interoperability in the health care industry:

• Health care Conformity Assessment
• eHealth Exchange Testing Program
• ONC (Office of the National Coordinator for Health Information Technology) Health IT Certification Program

The Ecosystem

The health interoperability ecosystem consists of medical professionals, systems and procedures that aim to share, transfer and retrieve all kinds of confidential, narrative and multimedia-based medical information.

The stakeholders, including hospitals, patients, researchers and systems, play a huge role in data generation, exchange and consumption.

Network Design

Medical data exchange takes place on the basis of three types of architecture.

• Centralized: The exchange entity collects and stores information in a repository to improve authentication, authorization and record-keeping abilities.
• Federated: This network enables easy information exchange through independent databases. Third-party users can access these files on request.
• Hybrid: This is a combination of centralized and federated architectures to help organizations benefit from the implementation of both.

Information Exchange Uses

Seamless information exchange is no longer a pipe dream, but a reality.

Imagine you need to refer your patient to see a specialty care provider — specialty care your organization doesn’t offer. You want to provide that specialist with your patient’s medical records so they can better understand your referral.

Interoperability has revolutionized the way health care providers can share patient information to streamline workflows and enhance patient care delivery.

You can digitally send the patient’s files to the specialist they choose, ensuring they have the information they need when the patient arrives for an appointment.

In this section, we’ve compiled some ways you can use interoperable exchanges to benefit your health care organization.

Medication Management

Enable electronic medication order transmission from prescribers to pharmacies to reduce manual errors and improve efficiency. For example, e-prescribing helps doctors send prescriptions directly to pharmacies using an automated tool.

Interoperability can additionally enable providers to access patients’ medication histories from different hospitals, labs and pharmacies to compare current regimens to their medication history for easy discrepancy and duplication identification.

Patient Information Management

Let patients securely send messages to their physicians with details about their symptoms, medications and medical histories. The physician can then use this information to make an informed diagnosis and recommend appropriate treatment.

In addition, physicians can share patient records, test results and other critical information with other providers involved in a patient’s care. This ensures that all doctors have access to the same information for improved and data-driven patient outcomes.

Lab Test Results

Interoperable exchange facilitates secure test results exchange among laboratories, hospitals and providers. This enables physicians to access test results quickly to make more informed diagnoses and treatment decisions.

Provider Alerts

Provider alerts are notifications that inform health care providers about important patient information, such as medication interactions, allergies or abnormal lab results.

Interoperability can enhance provider alerts in EHRs. Physicians can receive alerts from other departments or providers to make quick decisions in patient care.

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Organizational Considerations and Guidance

To enable meaningful data sharing, organizations need to establish trust among stakeholders. This involves taking into account various factors and using certain strategies to build trust.

Mentioned below are some crucial considerations to keep in mind.

Patient Consent

Conveying your exchange policies and obtaining patient consent for sharing their information is crucial for meeting regulatory requirements and sustaining patient trust. The use of different consent models is necessary to ensure compliance with regional rules and regulations governing data exchange practices.

Information Privacy

HIPAA provides a comprehensive framework for ensuring data privacy and security in the health care industry.

Here are some of the ways in which HIPAA safeguards patient information:

Privacy Rule

The HIPAA Privacy Rule establishes national standards for protecting the privacy of individuals’ medical records and other personal health information.

It requires health care providers and entities to implement appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity and availability of protected health information (PHI).

Security Rule

The HIPAA Security Rule sets standards for protecting electronic PHI (ePHI) in all forms, including stored, transmitted and received data. It mandates the use of appropriate safeguards to ensure the confidentiality, integrity and availability of ePHI.

Policies and Initiatives

The U.S. Department of Health and Human Services (HHS) has taken various steps to encourage the use of standardized approaches to improve interoperability in the health care system.

One such effort is the enactment and implementation of legislation, regulations and guidance. The 21st Century Cures Act is one such example. It includes provisions that direct the ONC, Centers for Medicare and Medicaid Services (CMS) and other agencies to enhance interoperability in health care IT.

The Interoperability Standards Advisory (ISA) represents a public list of ONC recommended standards and implementation specifications to facilitate interoperability in health care IT. The ONC is responsible for evaluating and identifying these standards based on specific clinical interoperability requirements.

The other two advancing standards that the ONC project focuses on for precision medicine are in the areas of:

• Mobile health, sensor and wearable data.
• Social determinants of health (SDOH) data.

At an international level, The Global Digital Health Partnership, with over 40 governments and territories, government agencies and the World Health Organization, facilitates the successful implementation of digital health services.

The work stream activities proposed by the GDHP concentrate on addressing the growing challenges associated with sharing patient data among organizations, providers and patients.

Assessing EHR/EMR Systems Interoperability Capabilities

Transitioning from paper to EMR and EHR systems can be challenging. There are various factors to consider during your purchase journey, but don’t overlook the system’s interoperability capabilities. You need to ensure it can effectively exchange health information with other systems.

Here are some steps to check interoperability while buying an EHR/EMR:

• Check if the EHR/EMR system complies with interoperability standards set by organizations such as HL7, FHIR and ONC.
• Verify if the system supports data exchange using various methods such as direct messaging, APIs or Health Information Exchange (HIE) networks.
• Ensure that the system can integrate with other systems, such as laboratory systems or imaging systems, to import data into the EHR/EMR.
• Evaluate the system’s ability to exchange health information with other EHR/EMR systems, including those used by other health care providers, hospitals or clinics.
• Check if the system can exchange information with state or national health information exchange networks.

Stay ahead of the game by preparing for the current and future EHR/EMR trends shaping the health care industry, including increased interoperability, integration and standardization to protect sensitive health information.

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Next Steps

With the growing need for data sharing and care coordination, interoperability is becoming a top priority for health care organizations worldwide. As the health care industry continues to move toward a more digital and interconnected future, it’s essential to prioritize interoperability when selecting and implementing EHR/EMR systems.

By doing so, health care organizations can unlock the full potential of their data and create a more efficient, collaborative and patient-centric ecosystem.

But how do you pick the right EHR/EMR software? Use our comparison report to select the most suitable product for your organization.

How do you think interoperability will impact the future of health care and patient outcomes? Let us know in the comments!