In this blog post I want to discuss one of the most critical and consistent issues in health informatics – interoperability. I want to address the importance of interoperability in healthcare because I believe it is the foundation for advancing clinical decision support tools such as healthcare chatbots, mHealth apps and using predictive algorithms for diagnosis. Without an interconnected system and a way to integrate various forms of unstructured and structured healthcare data into a centralized system, this might stagnate progress.
- What is interoperability?
Interoperability can be defined as the ability for multiple computer systems to exchange information across platforms and use this information to drive improved outcomes. - Why is interoperability important to the field of health informatics?
Interoperability in the context of health informatics is critical because of the multiple sources of data which feed into the Electronic Health Record (EHR) or Electronic Medical Record (EMR) system. Some of these sources can come from administrative claim databases, laboratories, imaging systems, medical devices, and consumer devices. These past couple of years have resulted in a boom in consumer devices outputting real-time health data such as FitBits and various mHealth apps. In the future, being able to connect real-time patient generated data directly into the EMR or EHR, may help to tell the full story of the patient.
Interoperability is important because in order to get clear insights from the data coming in from these data sources which can hopefully advance patient care, we need to ensure the data is clean and in the proper format. In addition, we need to be aware of the risk of privacy and security breaches that might arise from accessing multiple sources of data. - Why does interoperability matter?
When patients can have their health information consolidated into one system regardless of if the patient visited their primary healthcare provider or decided to visit another clinic, this can help to reduce duplication of medical tests and costs. Connecting health information can also help to reduce the amount of data entry that clinicians are faced with on a daily basis and in some cases is leading to physician burnout, clinicians can focus on their patients instead of a screen.
Did I mention the cost savings? According to a study done in 2018 by Gardner, for Canada Health Infoway, interoperability contributes approximately to $1B worth of healthcare system value. It also saves the equivalent of 25 lifetimes of patient time per year. - What are some of the biggest barriers to interoperability?
Interoperability in healthcare systems can bring significant financial and health benefits to patients, so what’s the hold up? As with most things, the concept is simple but the execution is difficult.
Some of the barriers to interoperability in healthcare include financial costs required to integrate healthcare systems, privacy and government regulations to ensure healthcare data is protected and will not result in major breaches, lack of involvement of clinical stakeholders when building these integrated systems which can lead to reduced rates of adoption when using the system and lack of incentives for healthcare providers, to name a few major barriers.
A possible solution?
FHIR stands for Fast Healthcare Interoperability Resources, this is a standard which allows health data to be exchanged electronically across different organizations and systems. FHIR was developed by the Health Level Seven (HL7) International healthcare standards organization.
As FHIR continues to develop, this could act as a secure way for health data to be exchanged from a variety of sources of data from the EHR/EMR, data from the lab and eventually patient-generated data from FitBits and other mobile medical devices.
FHIR have also been developed to integrate with APIs (Application Programming Interfaces) which are tools which allow third parties to securely view databases of the primary organization. APIs can be quite flexible and can allow third parties to read, write or delete their data. For instance, when using the share button on Facebook or Twitter, what is happening is that the third party application through an API is accessing your Facebook or Twitter account to share the content you want to share.
This sharing of data securely with the help of an API between the hospital and other external parties (i.e. other hospitals, labs) could be possible with the development of FHIR and can present an exciting push forward for interoperability. For example, instead of just receiving information that the patient had a single seizure event, with this push towards interoperability and by gaining the ability to analyze several sources of healthcare data, we can obtain the whole medical history of the patient. - What is the future of interoperability?
With the rapid rise of telemedicine and other forms of digital healthcare data I believe more and more patients will want to have access to their health data. I also think before we dive into widescale use of medical algorithms we need to work on building effective interoperable systems which have the proper data linkages in place and have superior data quality and integrity. I think the future of interoperability lies in the hands of health informatics professionals who can provide necessary training, leadership and incentives to clinicians and government leaders, to help reduce some of these real barriers and challenges facing interoperable healthcare systems.
To finish off I would like to discuss an inspiring story which could not be done without the power of interoperability
Aidan Deschamps a 10-month old baby was screened for Spinal Muscular Atrophy (SMA) by the Children’s Hospital of Eastern Ontario, in Ottawa, just six days before Aidan was born. He is the first baby in Canada with the disorder identified through Ontario’s Newborn Screening program.
Ontario’s Newborn Screening is done through a heel-prick test shortly after babies are born and infants can be diagnosed within days of birth. As a result of the work that Newborn Screening does in collaboration with other genetic testing labs and the interoperability of these healthcare systems, the Newborn Screening program was able to reach out to the Deschamps’s family 10 days after Aiden was born. With the interoperability between these healthcare systems, clinicians were able to rapidly identify a rare genetic disease and make a difference in the life of this family. Stories like these are just the tip of the iceberg of the benefits that can come from fully interoperable healthcare systems and I hope to continue to report on advances in this topic in the future.
Comment down below, what do you think are the biggest barriers to interoperability in healthcare?
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