The buzz word: Interoperability

Interoperability for EHR is a complex nut to crack. As I am becoming more knowledgeable about the topic it is apparent that a number of really smart people are making some progress on providing solutions, and there is still a lot of work to be done. That being said, it is helpful to see where we are right now.

What does interoperability mean? As defined by eHealth Initiative, it is the ability of two or more systems or components to exchange information and to use the information that has been exchanged accurately, securely, and verifiably, when and where needed. (Reference: http://www.ehealthinitiative.org/).

Right now there are two forms of interoperability. They are differentiated by how the data is initiated; one is initiated by a push and the other a pull. In the push initiated form, a provider will see a patient and “push” the information to another provider. This push is an encrypted message sent over the internet. Some organizations call this a Direct operation. The push form is inexpensive and many providers have the capabilities for this type of interoperability through their secure email systems. A challenge with this form is that the receiving provider does not know the message is being sent until it arrives and may not need or expect the information. In addition, the message may not contain the health information necessary for the care of the patient, or it may not be timely. The second form of interoperability tries to solve these challenges.

The second form of interoperability is initiated by a pull of information. A provider is looking for information on a particular patient and “pulls” it out of the available EHR systems. Through a health information exchange (HIE) a query checks for the existence of data and if present pulls it back. To do this EHRs have to follow standard data and technical specifications plus the providers have to use interfaces to translate the data to the HIE. To make pulled data timely to the provider, many organizations need to be connected to the HIE. The challenges to connectivity are many including duplication of records, ability to handle an opt-out process for patients, integration into the EHR so providers can access the information without going to a separate system, and ease of use. Despite these challenges progress is being made toward the goals.

The federal government has had interoperability in its priorities for a long time. Beginning with the Department of Health and Human Services goals under the Bush administration in 2004, Health Information Technology has been a priority. Now that objective is applied into the world of EHR. Minnesota has an interoperability mandate of 2015. This is putting pressure on the software vendors, HIE systems, and providers to find solutions. As I stated, there are some really smart people working on this challenge and I believe we will get there because it is in the best interest for the patient.