Interoperability: Issues, Challenges, Solutions

1. Interoperability:Issues, Challenges, Solutions Bill Lober, MD MS Associate Professor, Health Informatics and Global Health Schools of Medicine, Nursing, and Public Health University of Washington Director of Informatics International Training and Education Center for Health

2. Overview • Why start with Interoperability? • What is Interoperability? • Definition, Types, Assumptions • Principles • Software engineering • National Institutes of Health • Barriers (Non-technical) • Canada • Europe

3. Session Theme Why Start With Interoperability? • Interoperability, Standards, and Architecture Architecture to Support Standards-based Interoperability Standards-based Interoperability Interoperability HL Lab Pharm HIV PMIS PMIS VCT HIV VCT HL7 messages SDMX-HD Provincial/District Reporting National Reporting Supply Chain/Stock Mgt Surveillance/Case Reporting National Patient Index Billing/Utilization/Insurance Commercial Ordering HL7 CDA HL7 X.12?EDIFACT? HL7 messaging Referral Summaries

4. Definition • “Interoperability” means the ability to communicate and exchange data accurately, effectively, securely, and consistently with different information technology systems, software applications, and networks in various settings, and exchange data so the clinical or operational purpose and meaning of the data are preserved and unaltered.

5. Definition • “Interoperability” means the ability to communicate and exchange data accurately, effectively, securely, and consistently with different information technology systems, software applications, and networks in various settings, and exchange data so the clinical or operational purpose and meaning of the data are preserved and unaltered. Like going to the Moon… Definition from US Presidential Executive Order2006-Aug-22, “Majority of Americans shall have access to electronic health records by 2014”

6. Challenges • “Interoperability” means the ability to communicate and exchange data accurately, effectively, securely, and consistentlywith different information technology systems, software applications, and networks in various settings, and exchange data so the clinical or operational purpose and meaning of the data are preserved and unaltered. Like going to the Moon… Definition from US Presidential Executive Order2006-Aug-22, “Majority of Americans shall have access to electronic health records by 2014”

7. 5 Types of Interoperability* • Priority areas for achieving interoperability • Unique person identifier • Meaning (semantics) • Structure/format (syntax) • Core data sets • Data quality and use *Hammond WE, Bailey C, Boucher P, Spohr M, Whitaker P. Connecting Information To Improve Health. Health Affairs. 2010;29(2):284 -288.

8. Underlying AssumptionsSupporting Health Interoperability* • Interoperability is preferable to large integrated systems • Apparent simplicity brings risk, creates barriers • Interoperability can bring flexibility, innovation, ownership • Record data only once, but allow it to be reused in other systems. * Bailey C, Boucher P, Kibbe D, et al. Interoperability Standards for Health Information Systems. 2008. Available at: http://www.dbmotion.com/multimedia/upl_doc/doc_281008_174695.pdf.Accessed March 15, 2011.

9. Assumptions About“Other Systems” (and Architecture) • For Example: • EMR supports certain business rules • Doctors review old records • Doctors see labs and medicines • Reporting to hospital administration • Lab has other business rules • quality, test kit inventory, supply chain, analyzer interfaces • …if an EMR designer adds a lab module, it will add the functions to serve the EMR… • … if a Lab designer builds a system, it will serve the needs of the lab • … the goal is for systems to support their own business areas, and exchange the information they need. • All information systems operate like they are at the center of the architecture • To connect them (scalable interoperability) • All systems have to be well described, in functional requirements • The business processes that require data interactions should be well described in use cases • The standards used to support those data interactions, and the specific ways those standards are to be used, should be integrated with the use cases as interoperability profiles.

10. Assumptions About“Other Systems” (and Architecture) • All information systems operate like they are at the center of the architecture • To connect them (scalable interoperability) • All systems have to be well described, in functional requirements • The business processes that require data interactions should be well described in use cases • The standards used to support those data interactions, and the specific ways those standards are to be used, should be integrated with the use cases as interoperability profiles.

11. Software EngineeringPrinciples of Interoperability • No Clear Distinction Between Systems and Systems of Systems • Interoperability Problems Domain Independent • Solutions Cannot Rely on Complete Information • No One-Time Solution Is Possible – Incremental Development is needed. • Networks of Interoperability Demonstrate Emergent (New) Properties * Dennis B. Smith. Guiding Principles for Interoperability. Carnegie Mellon Software Engineering Institute; 2004. Available at: http://www.sei.cmu.edu/library/abstracts/news-at-sei/eyeonintegration20042.cfm. Accessed March 27, 2011.

12. US National Institutes of HealthIntegration Principles • Loosely Coupled Interfaces • Publish Integration Points • Platform Independent, Open Standards • Reusable, Shared Services • Integration Change Management • Minimize Application Impact * NIH Enterprise Architecture - Integration Principles. 2004. Available at: http://enterprisearchitecture.nih.gov/ArchLib/AT/IA/Integration/IntegrationPrinciples.htm. Accessed March 27, 2011..

13. Political, Social, Policy Barriers to Interoperability in Canada • Political – distributed control and funding mechanisms • Social – distributing knowledge promotes equality and erodes boundaries • Policy – • diverse policies set at province level • financial incentives can limit information sharing • expectations change faster than policies * Juzwishin DWM. Political, policy and social barriers to health system interoperability: emerging opportunities of Web 2.0 and 3.0. Healthc Manage Forum. 2009;22(4):6-16.

14. European CommissionICT Standards in the Health Sector • Political barriers: Different national and regional health system standardisation approaches. • Standards Development Organisations (SDO) barriers: ...hindered by competition between different SDOs. • Company barriers: ICT firms seek positive returns, ...conflicting standards can be good for business of companies. • ICT user barriers: ...expensive to identify the best standards, convert existing data. * The European e-Business Market Watch - Studies. Available at: http://www.ebusiness-watch.org/studies/special_topics/2007/eHealthStandards.htm. Accessed March 28, 2011.

15. Syntax, semantics, and…?