One of the most important challenges of the adoption of healthcare information technology (IT) systems is making sure information is transferred seamlessly from one hospital to another. As a result, interoperability across different institutions is critical. Not using the same standards and nomenclature can lead to restricted data access, increased cost and inefficiencies, and poor data quality.
Simply put, standards of interoperability are the data protocols that ensure data shared between different health systems is equally usable by all parties. For optimal function, standards of interoperability should ensure that shared data is readable by everyone, including both human beings and the machines that help automate our data sharing and operational processes.
However, ensuring different healthcare systems work upon the same standards is incredibly complicated. Organizations have to deal with gaps in data standards, overlapping standards, legacy technology, and no overarching mechanism or organization that supervises the usage of data standards.
In this blog post, we’ll look at the types of data collected in a healthcare organization, what kinds of data exchanges can occur and why standards of interoperability are key for the healthcare industry.
Standards of Interoperability Begin with Data Collection
Any patient who enters a hospital generates two types of records: administrative and clinical. According to the Association for Information Systems, clinical information includes “a patient’s problem list, medication record, history and physical, progress notes, consultation reports, physicians’ orders, (…) and a discharge summary.” Administrative information, on the other hand, ranges from demographic information from the patient to consents, and insurance-related processes.
Health data collection is based on two types of electronic records. The first one is the electronic medical record (EMR), which “is exclusively related to patient information within one healthcare organization” (Association for Information Systems). Basically, they’re the digital version of a hard copy of data files that contain a patient’s medical history. EMR technology is now essential to healthcare organizations, as it now substitutes paper charts with dynamic visualizations of a patient’s blood pressure, oxygen levels and additional relevant information.
An electronic medical record shouldn’t be confused with an electronic health record (EHR), which refers to the collection of information a patient has across many hospitals or healthcare institutions. Any comprehensive hospital information system (HIS) contains hundreds of records and relevant information about drug names, procedures and so on. Without the use of naming conventions or data standards, it would be very difficult to share key information about a patient across different hospitals.
Interoperability, according to the Healthcare Information and Management Systems Society, is “the ability of different information systems, devices and applications to access, exchange, integrate and cooperatively use data in a coordinated manner.” Ideally, healthcare organizations should strive for a level of interoperability that includes governance, policy, legal and organizational aspects to ensure seamless data sharing.
How Do Healthcare Data Standards Work?
Healthcare organizations should strive for semantic and functional interoperability, meaning that they use a common language of communication to support common functions and procedures. Standards are the best way for reaching interoperability, as they provide a common set of expectations to allow a seamless exchange of information.
The only bodies focused on the development and creation of standards are standards development organizations (SDO), which are accredited by the American National Standards Institute (ANSI) or the International Organisation for Standardization (ISO). As HIMMS points out, there are over 40 organizations in the health IT arena, and not all of them are responsible for creating standards.
When it comes to standards, healthcare organizations work with a vast array of categories, ranging from terminology and content to privacy and security. The following table shows some examples of standards across different areas.
Type of Standard
Current Procedural Terminology (CPT), National Drug Code (NDC), Systematised Nomenclature of Medicine-Clinical Terms (SNOMED-CT)
Consolidated CDA, HL7’s Version 2.x, HL7 Version 3 Clinical Document Architecture (CDA)
Digital Imaging and Communications in Medicine (DICOM), Direct Standard, Fast Healthcare Interoperability Standards (FHIR)
Privacy and Security
Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule and Security Rule
Enterprise Master Patient Index (EMPI), Medical Record Number (MRN), National Provider ID (NPI), Object ID (OID)
Introducing FHIR Standards of Interoperability
Due to the wide range of organizations and standards available, it is no surprise that healthcare institutions face a series of problems due to inconsistencies. These include overlapping standards, gaps in data standards or the need to create multi-purpose standards designed to reach interoperability. For example, administrative codes such as ICD-9-CM work great for research systems, but are too general for an EHR.
One of the most recent solutions is the Fast Healthcare Interoperability Resource (FHIR), created by HL7 International. As the organization states, it’s “a base set of resources that, either by themselves or when combined, satisfy the majority of common use cases”. FHIR standards help developers build standardized applications that enable data access regardless of the system.
What makes FHIR standards so different? First of all, any FHIR resource can be grouped into an individual packet of information to create clinical documents. Also, FHIR uses standardized application programming interface (API) to transcend the document-based environment hospitals usually work in. This allows any application to be plugged into an EHR operating system and feed information directly.
So far, FHIR data standards are being used by major organizations such as Epic and Mayo Clinic as the basis for a clinical decision support model. Other institutions are exploring interoperability efforts through the creation of a FHIR centerpiece that allows free data flow across different systems.
Hakkoda’s FHIR Data Loader
Although FHIR standards have advanced greatly in achieving seamless interoperability, they still remain difficult to map and to load. Because FHIR resources have been designed to be both human- and machine-readable, feeding and extracting data is challenging. Hakkoda recently released the FHIR Data Loader accelerator, which removes the complexities of getting FHIR data ready for your business.
The FHIR Data Loader is a low code solution that helps healthcare teams load continuously to FHIR servers while removing the complexities of manual code processing. This helps your team future-proof data pipelines and convert your data for analytics processes.
At Hakkoda, we’re committed to seamless healthcare data sharing. Our team of expert architects and engineers are constantly creating flexible solutions directed towards the delivery of effective, value-based care.
Contact us to learn more about how the FHIR Data Loader can help your data get business ready.