What is Interoperability in Healthcare?

Beth Plumptre
March 29, 2023

Digitization has transformed healthcare into an interconnected network of databases, systems, and applications. This advancement has shifted care delivery from a function documented across paper files, fax machines, and metal cabinets — to one backed by Electronic Health Records (EHR) and Health Information Exchanges (HIEs). As of 2021, The Office of the National Coordinator for Health Information Technology (ONC) reported that nearly 4 in 5 office-based physicians and close to all non-federal acute care hospitals adopt a certified EHR for efficient access to health information.

In a data brief, The Office also confirmed around 70% of hospitals across America participated in at least one HIE network. But despite being widely available, most software systems present in healthcare today still operate on interfaces that can’t support seamless access to their respective records. The distinct software architecture used across these platforms often complicates the interconnected nature of present-day healthcare services — which is where interoperability comes in.

Healthcare interoperability applies one central premise: that electronic health data spread across EHRs, public health registries, e-prescribing systems, telemedicine platforms, and other systems — be easily accessed and exchanged for improved care delivery. In 2024, the ONC aims to achieve healthcare interoperability across the United States. This guide will examine the use cases of an interoperable system, and its promise for a patient-centric healthcare environment. Read on to learn the different structures of interoperability, the benefits of its application, and potential challenges to the wide adoption of this system.

What is Healthcare Interoperability?

In our present landscape, we are witnessing healthcare at its most democratized. One patient may keep track of a chronic condition like diabetes through a mobile application, while receiving essential mental healthcare from a telehealth service. This individual may also have information stored across hospital patient portals that keep track of visits, medications, allergies, and so on. While existing in silos, each platform contains information that when combined — paints a fuller picture of a patient's health status.

Think of interoperability as the line stretching between health applications, telehealth services, hospitals, payer portals, and more, to link their information. According to the American Healthcare Information and Management Systems Society (HIMSS), interoperability “is the ability of different information systems, devices and applications (systems) to access, exchange, integrate and cooperatively use data in a coordinated manner, within and across organizational, regional and national boundaries, to provide timely and seamless portability of information and optimize the health of individuals and populations globally.” Because IT systems are developed by manufacturers who build their infrastructure on different hardware and software components, applications, or databases — this can restrict pairing, communication, and information exchange across computerized networks. Interoperability coordinates these different systems and integrates their data for easy access and exchange.

Levels of IT Interoperability

Physicians, researchers, patients, and other players can access centralized medical, financial, and related information with an interoperable system. To stay on track to the nationwide goal of interconnectedness, the HIMSS has identified four levels of interoperability across health IT systems. These levels determine a health organization's capacity for sharing and exchanging relevant information.

Foundational Interoperability

At the foundational level, one IT system can connect and share data with another. Otherwise known as simple transport, relevant software platforms and document management systems (DMS) share and receive data between systems at this level safely. The system accepting information typically requires human or technological assistance to interpret the shared data.

Structural Interoperability

This tier is also known as technical interoperability. It defines the structure of data to be exchanged and interpreted. Standards of health information exchanges (HIE) such as Fast Healthcare Interoperability Resources (FHIR) and Health Level Seven (HL7) determine specifications for data exchange across systems. These standards introduce homogeneity, preserving the meaning and purpose of the data exchanged.

Semantic Interoperability

This level ensures that two or more systems can share, interpret, and use exchanged information. This is especially important across organizations with different software systems or other formats. Semantic interoperability employs standardized data structures to guarantee that patient information on a procedure, diagnosis, or lab result is interpreted similarly across health organizations.

Organizational Interoperability

At this level, organizations are fluent in the technical and non-technical aspects of data exchange between systems. Here, social, legal, organizational, and policy considerations are taken into account for seamless and coordinated data exchange.

The Role of APIs in Interoperability

Interoperability aims to integrate different IT systems into coordinated, easily accessible information resources. To reach this goal, healthcare organizations and other entities are adopting public or open Application Programming Interface (API) frameworks. 
APIs are multilingual interpreters of sorts. These programs speak the various languages employed across health IT systems, enabling open communication to ease information flow. FHIR APIs are the industry standard for meaningful system exchanges. 

FHIR APIs present patient records as a set of resources of the same structure — this removes typical roadblocks, ensuring data is seamlessly accessed by players. A valuable intervention, this interface is used widely across health sectors. In 2020, healthcare API traffic grew by more than 400%.

There are three general categories of healthcare APIs:

  • Internal APIs: these facilitate information communication and exchange within a healthcare organization. For instance, an internal API used in a hospital may permit its pediatrics department to access patient data from an EHR system to review potential allergies.
  • External APIs: simplify communication between different organizations or information systems. An external API can connect a hospital with a national HIE to improve care coordination.
  • Third-Party APIs: these are available outside a health organization. These APIs enable organizations to access health information of their patients from external HIEs and EHRs, via a solution such as Metriport.

APIs are a powerful, unseen player in everyday healthcare activities. This software is to thank for integrating pharmacy services with hospital EHR systems, plus streamlining the medication order and refill process. An API can also pair data from wearables with EHR systems providing necessary data for remote patient monitoring. This interface also performs appointment-scheduling functions, billing-support between providers and payers, and even data exchange between health organizations.

The Future of Interoperability in Healthcare

Interoperating systems in healthcare hold many benefits at individual, organizational, and national levels. By granting patients clear access to their health information, better control and trust are developed in the healthcare ecosystem. Beyond improving efficiency and reducing costs, interoperable systems have introduced a fine layer of trust in data security across healthcare operations, helping to improve care processes and outcomes greatly. At Metriport, we definitely see open-source software playing a big role in this.

However, while established as the clear future of healthcare operations, interoperability faces constant challenges that span high expense, data sharing restrictions, non-standardization, and a need for more literacy among healthcare players. As a vital step towards achieving radical interoperability, it's important for governments, physicians, payers, and other affected organizations to prioritize data input standardization.

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