Basic, structural and semantic interoperability
As administrators re-evaluate their IT resources to meet the requirements for value-based care, they should examine the three dimensions of interoperability: basic, structural and semantic interoperability.
Let’s clarify by means of an example.
42-year-old Sean recently moved from Ireland to Spain to take up his new job in a multinational IT company. A few weeks after arriving, he falls ill, consults his local (Spanish) GP and is transferred to a nearby hospital for further tests. Depending on the level of operability established, the hospital has to initiate different steps.
No interoperability
There is no way of exchanging health data from one health ICT system to another.
Sean has to undergo a full set of lengthy investigations for the doctors to find out the cause of his severe pain as neither the results from the local GP as those from his Irish GP are available at the hospital due to a lack of interoperability possibilities.
Basic interoperability
The most basic tier of interoperability: two systems can exchange data but the receiving IT system does not necessarily need to be able to interpret the exchanged data. A person is needed to interpret that information and what it means to a patient’s care. In other words, rather like a posted or faxed letter, the document has to be read by the receiving clinician in order to understand the information in it. No computer analysis is possible.
Sean’s doctor in the hospital is able to receive electronic documents that were released from the Irish GP as well as his local GP upon request. Unfortunately, none of the available doctors in the hospital is able to translate the Irish document. Only human intervention allows interpretation of the information submitted by the local GP.
Structural interoperability
The recipient system can interpret data at the data field level so that the clinical or operational purpose and meaning of the data is preserved. This requires less human interpretation or data re-entry, as part of the data received can be reconciled into a patient’s health care record without extensive manual effort.
The Spanish hospital’s information system is able to import parts of Sean’s Electronic Health Record released by his Irish GP as well as the local GP that he visited just hours earlier.
Although both health files received contain mostly free text, fragments of high importance such as demographics, allergies, diagnoses, and parts of medical history are encoded using international coding schemes.
The hospital information system can automatically detect, interpret and meaningfully present this data to the attending physician.
Semantic or advanced interoperability
The highest level of interoperability: There is a meaningful exchange of information between the two systems. The treating physician will receive the clinical data relevant to a patient’s care depending on the setting of care and the patient’s condition. This info will be fully integrated in the recipient digital system.
For example, an allergy included in the communication can be added to the allergy list already held by the hospital. The same for a medication list: the received list and the already held list can be compared and discrepancies highlighted to the Spanish doctor.
In this ideal situation and after thorough authentication took place, the Spanish hospital information system is able to automatically access and interpret all necessary medical information about Sean and present it to the physician at the point of care.
Neither language nor technological differences prevent the system to seamlessly integrate the received information into the local record and provide a complete picture of Sean’s health as if it would have been collected locally.
Furthermore, the anonymised data feeds directly into the tools of public health authorities and researchers.
