Why Data Standards are Essential for True Interoperability and Ease of Integration

Dr. Koray Atalag, Chief Health Informatics Officer (CHIO) and Head of Research at The Clinician, provides insight on the HL7 FHIR standard, what industry-wide adoption could mean for interoperability, and a look ahead to what’s coming next.

What interoperability means for healthcare

Interoperability is actually a very old concept which was originally called ‘architectural match,’ or mismatch: the ability of different information systems to exchange, store, understand, and process data.

A common misconception conflates interoperability with integration, but it's not quite so. Interoperability has two key elements:

• If the data between two systems can be shared and understood, this enables the collection, aggregation and analysis of data from multiple systems, without any data being transformed.

• With interoperable systems there are no complex mappings, vastly simplifying integration projects—allowing implementation to be achieved more quickly and with significantly reduced costs.

What's usually referred to within healthcare and the electronic health record community is actually semantic interoperability. This is not merely the ability to exchange data, but the ability for systems to understand the concepts and information contained within this information exchange, without any human intervention.

In the healthcare context, this means exchanging clinical or administrative data about patients or healthcare services between systems, with no confusion between the meaning of data in System 1 versus System 2. This capability is a step up—from a basic exchange of technical data, to an exchange of information and its understood meaning. Interoperability in this case is really the ability to match the concepts or the configurations of the data from one system to another.

As an example, consider the lack of a universally accepted ethnicity list: Australia and New Zealand each have their own list of values for ethnicity data, resulting in a large amount of variation. If a system with more granular data—for example, 14 values in New Zealand—sends data to a system with only 9 values, certain values will not be matched, and the meaning of that data will be lost.

Adoption of standards to achieve true interoperability and ease of integration

First and foremost, true interoperability and ease of integration relies upon the use of existing standards, such as HL7’s suite of standards, specifically the new FHIR (Fast Healthcare Interoperability Resources) and the older version 2.

Standards like HL7 FHIR are essential for ensuring the meaning of data is preserved as it’s exchanged between the systems. Successful implementations of large digital health projects, whether nationwide, statewide, or enterprise-wide, is primarily due to the use of data interoperability standards.

Another key element to success is agreeing on some common business processes: How do you manage patient admission? How do you transfer patients from one ward to another? What is your discharge process? Must final sign-off come from the clinician, or can it be done by nurse practitioners?

The process of interoperability is not something that has been standardised.

Where there is a framework for data and process interoperability, those projects can be implemented very successfully. Where vendors and providers agree on using standards, then integrations can be much easier and less costly.

However, it’s not only about preserving the structure of the records, but preserving the meaning of individual concepts like diagnosis, procedures, and medications. That's where clinical terminology systems like SNOMED CT, LOINC, etc, come in—the combination of clinical terminology standards attached to the interoperability data structure standards is what makes semantic interoperability possible.

The potential made possible by data standards

Industry has already embarked on a very ambitious journey in adopting the latest FHIR standards. We’ve seen rapid adoption in the United States, Australia, New Zealand, and some of the European Union. This enables integrations and exchange of data between many of these information systems. What wasn’t possible (or even thinkable) a decade ago is now a reality.

As a result, within the digital health space, many vendors and their partners are forming what may be called ‘ecosystems.’ They create their own marketplaces and very clearly defined APIs, facilitating third-party innovations or information system providers.

For example, in an electronic medical record (EMR) system like Allscripts with a standards-based application that shows cardiovascular risk, the integration doesn't require any technical work at all: the doctor can literally drag and drop to his own sidebar.

This ecosystem approach, and the ability for applications to be plugged in and out, is the hottest topic at the moment, and it's happening due to the standards adoption. It's the standards that are making possible our ability to aggregate and make use of data, and also increasing the ease with which integrations can be done.

 How The Clinician can help

At The Clinician, we understand the importance of standards adoption from the inside out: our CHIO Dr. Koray Atalag is a current member and former vice chair of the HL7 New Zealand management board. 

We build and modify our systems according to the highest-quality standards and best practices, making sure we are always ahead of the game.

 In fact, we built ZEDOC to follow both elements of interoperability standards: incorporating data structure and semantics, but also capable of encoding certain elements in our data set with the clinical terminology, leaving no ambiguity about the meaning of the data exchanged.

Due to the nature of its design, our ZEDOC platform is a natural fit to play a major role in the future of interoperable care.

Contact us to see ZEDOC in action and learn more about the interoperable digital health solutions we make possible.