Defining Interoperability in Healthcare Systems

Defining Interoperability in health care SystemsInteroperabilityAccording to Healthcare data and Management Systems Society (HIMSS), a not for profit organization focused on improving Healthcare by the use of Information Technology, interoperability is the ability of antithetic cultivation engineering systems and software applications to communicate, exchange data, and use the information that has been exchanged. Data exchange schema and standards should permit data to be percentd across clinicians, lab, hospital, pharmacy, and patient regardless of the application or application vendor. Interoperability representation the ability of health information systems to work together within and across organizational boundaries in regularise to advance the health position of, and the effective delivery of health care for individuals and communities.1Interoperability in Healthcare Information Systems is important for delivering quality healthcare and reducing healthcare costs. Altho ugh achieving interoperability is sort of a challenge both because there are competing standards and clinical information itself is very complex, there have been a number of successful industry initiatives much(prenominal) as Integrating the Healthcare Enterprise (IHE) Profiles, and the epSOS initiative for overlap electronic Health Records and ePrescriptions in Europe.There are three levels of health information technology interoperability 1) Foundational 2) Structural and 3) Semantic.We shall try to define these terms in simple words in order for the reader to be able to beneathstand not besides the differences between them, but also to understand the complexity that lies in Healthcare Information Systems.Technical Interoperability is usually associated with hardware/software components, systems and platforms that enable machine-to-machine communication to watch place. In this kind of interoperability we are mostly interested in communication protocols and the infrastructure needed for those protocols to operate and not about the interpretation of data go from on system to another.Structural or syntactical Interoperability is usually associated with data formats. Certainly, the messages transferred by communication protocols need to have a well-defined syntax and encoding. This substance it is ensured that data exchanges between information technology systems can be interpreted at the data field level.Semantic Interoperability is usually associated with the meaning of content and concerns the world rather than machine interpretation of the content. We are talking about interoperability at the highest level, the ability of computer systems to transmit data with clear, shared meaning. Thus, interoperability on this level means that there is a common understanding between people of the meaning of the information being exchanged.Most widely used contemporary Interoperability standards in HealthcareIn Europe, Technical committee 251 (TC 251) of the Eu ropean Committee for Standardization, holds the responsibility for the standardization of Healthcare IT messages. The goal is to achieve compatibility and interoperability between independent systems and to enable modularity in Electronic Health Record systems. Various workgroups establish requirements for health information structure in order to support clinical and administrative procedures, technical methods to support interoperable systems. In addition they establish requirements regarding safety, security and quality.In the United States HL7 committee is a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and tie in standards for the exchange, integration, sharing, and retrieval of electronic health information. HL7s 2,300+ members include approximately 500 corporate members who represent much than 90% of the information systems vendors serving healthcare.In parallel with HL7, the ACR-NEMA2 committee established the DICOM standard (Digital Communications in Medicine) that is today the most widespread standard for the format of the pictures that medical equipments produce. DICOM enables the transfer of medical images in a multi-vendor environs and facilitates the using and expansion of picture archiving and communication systems. DICOM enables the integration of scanners, servers, workstations, printers, and network hardware from multiple manufacturers into a picture archiving system (PACS). The different devices come with DICOM conformance statements which understandably state which DICOM classes they support.During the last days an initiative is in progress from IHE (Integrating the Healthcare Enterprise) in order to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care. Systems developed in accordance with IHE communicate wit h one another better, are easier to implement, and enable care providers to use information more effectively.3 Systems that adopt the IHE Integration profiles collaborate in a more standard way, are easier to be implemented and help Healthcare providers to use information more efficient with the aim of providing better care.IHE facilitates users and developers of healthcare information technology to come together through an annually recurring four-step processClinical and technical experts define critical needs for information sharing (use cases).Technical experts create detailed specifications for communication among systems to address these use cases, selecting and optimizing established standards.Industry implements these specifications called IHE Profiles in HIT systems.IHE tests vendors systems at carefully planned and supervised events called Connectathons. every IHE Profiles are publicly available and free of charge in IHEs website. Until today more than a hundred companies a re accredited by IHE having materialized at least one profile.The IHE ProcessThe existence of so many standards creates challenges difficult to address. Their usage is not always well known, interoperability between applications using different standards is often not documented and some of them conflict. The market for interoperability standards is maturing, even though slowly. The third version of the HL7 standard is progressively being adopted by the health industry, and intersection with Europes CEN/TC 251 standardization work is under way. The IHE initiative is producing useful use cases that standardize communication between various health information system components.In the future, the knowledge domain Health Organizations eHealth Standardization Coordination Group can also be expected to play a more prominent role in developing ICT standards for the health sector.4EPSOS (European Patients Smart Open Services)A very interesting and ambitious EU initiative that falls under the Interoperability domain is epSOS. The project aims to design, build and evaluate a service infrastructure that demonstrates cross-border interoperability between electronic health record systems in Europe5.EpSOS attempts to offer unseamed healthcare to European citizens. Key goals are to improve the quality and safety of healthcare for citizens when travelling to another European country. Moreover, one other goal is the development of a matter-of-fact eHealth framework and ICT infrastructure that enables secure access to patient health information among different European healthcare systems. epSOS can make a significant contribution to patient safety by reducing the frequency of medical errors and by providing quick access to documentation as well as by increasing accessibility of ones prescribed medicine also abroad. In emergency situations, this documentationprovides the medical personnel with information and reduces the repetition of diagnostic procedures. epSOS aims at bui lding and evaluating a service infrastructure demonstrating cross-border interoperability between Electronic Health Record Systems in Europe. Sometimes called a large-scale European implementation, epSOS is impelled forward by many European member states, the first European eHealth project gathering such a large number of countries in practical cooperation.Interoperability in Greece Healthcare InformaticsIn the next pages, we give try to investigate the introduction of Interoperability in ICT systems in the Greek Health sector.Until the dawn of the degree centigrade in the Healthcare IT arena in Greece, emphasis was given in Enterprises Resources Planning (ERP) applications with the aim to better monitor financial data and streamline render chain planning. The biggest from the Public Sector hospitals have incorporated some Information systems in this area, that were manufactured by E government for Social Security (IDIKA), a government organization with the mission to supply IT applications in Hospitals and Social Security organizations. Private hospitals were more advanced and the biggest of them have started implementing more integrated systems, some of them international, the likes of YGEIA hospital or MITERA obstetric clinic that implemented SAP ERP. These applications were built in a monolithic way, and the various modules were tightly connected together. Hospital Information Systems (HIS) and laboratory Information Systems (LIS) were in their infancy and each Healthcare provider was acting as a silo. Hence the need for Interoperability was not considered crucial.The need for interoperability among the disparate systems within a hospital and among the hospitals of the same region was firstly introduced as a need in the Integrated Information Systems projects that were carried out in the Healthcare Regions and were funded by the Operational Programme Information Society of the 3rd CSF. The design of these projects started in 2001 and the first one was tendered in 2003. The purpose of those projects was the infusion of IT technology in the management of the Healthcare organizations, in order to support the changes in the organization of the Healthcare System in Greece that was moving towards regionalization and the upgrade of the services towards patients.In these projects the need for Interoperability was verbalised in the following four aspectsInteroperability within a hospital with applications and systems already in place.Interoperability among the sub systems that would be provided in the scope of the tenders for each hospital, wherever needful (ERP, HIS, LIS etc)Interoperability with future systems, which were not part of the projects, like RIS and PACS.Interoperability among the different regional Health Authorities and Ministry of Health systems (mostly future ones) like Blood Bank, the National Center for urgency Help () etc.The standard that was selected in order to ensure a common messaging standard was HL7 ver 2 .x.All these projects finally materialized after several years of delays, with different level of success between Regions but also between hospitals inside the same region. The reasons for the rather poor results in interoperability are many and we will try to illustrate the main barriers. At this point we should note that there is official data in the form of a study of the current status of interoperability in Healthcare.Poor technical specifications for the interoperability aimed to be achieved. The standard (HL7) selected was adequate and mature, but detailed specifications were missing.There were no national codifications that could facilitate the set up of the systemsThe institutional framework was not clear and the obligations derived were not documentedThe maturity and openness of the solutions that were implemented varied a lotThe applications in place could not interoperate through HL7, so this aspect could not be accomplishedThere was no strategy and specifications for th e national EHR for the implementations to be benchmarked against.As a conclusion someone could take that despite that results were not as expected, it was the first time that interoperability in Healthcare was ever mentioned and required as a mandate. Several use cases were implemented and a step towards openness has been achieved. Many lessons were learned and the evolution of HC ICT will definitely incorporate Interoperability as an integral part.In recent years interoperable eHealth in Europe or even on an international scale is a fact. The European Commission is supporting collaboration initiatives through its policy initiatives and funding instruments and the World Health Organization (WHO) is promoting worldwide eHealth through its Global Observatory for eHealth.1 HIMSS, Definition of Interoperability. Approved by the HIMSS Board of Directors, April 5, 20132 American College of Radiology (ACR), National Electrical manufacturers draw (NEMA).3 http//www.ihe.net/About_IHE/4 See http//www.who.int/ehscg/en/5 http//www.ihe-europe.net/eu-projects/epsos