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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. Overview.

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interoperability issues challenges solutions

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

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

definition
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.
definition1
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”

challenges
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”

5 types of interoperability
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.

underlying assumptions supporting health interoperability
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.

assumptions about other systems and architecture
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.
assumptions about other systems and architecture1
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.
software engineering principles of interoperability
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.

us national institutes of health integration principles
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..

political social policy barriers to interoperability in canada
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.

european commission ict standards in the health sector
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.