Importance of EHR Interoperability

Level 0 - NO Interoperability

Stand-alone systems which don't have interoperability. This involves systems that cannot share information and are restricted to individual system boundaries.

Level 1 - Technical Interoperability

This level of interoperability uses a communication protocol for sharing data between systems. It deals with technical aspects of interoperability like communication protocols, interconnection services, and data exchange format.

Level 2 - Syntactic Interoperability

This level implies the capability of two or more systems to share data and services through mutually interoperable protocols like High-Level Architecture (HLA).

Level 3 - Semantic Interoperability

This interoperability specifies the ability of two or more systems to positively decode the information exchanged meaningfully and exactly to generate favorable results as defined by end-users. Semantic interoperability means that the actual meaning of shared information is understood by communicating systems.

Level 4 - Pragmatic Interoperability

This level of interoperability is acquired when the interoperating systems know the methods and procedures that they are using.

Level 5 - Dynamic Interoperability

Two or more systems are said to have dynamic interoperability when they understand the state changes taking place and are capable of taking advantage of those changes.

Level 6 - Conceptual Interoperability

Conceptual interoperability is attained when assumptions and constraints of purposeful absorption of reality are aligned. However, interoperability in healthcare has different meanings such as -

• Interoperability of massages (data) to be shared among healthcare applications.
• Interoperability of electronic health record (EHR).
• Interoperability of patients' health records.
• Interoperability of other business processes.

Lack of Consistency

Organizations like CHIME and HIMSS are putting their efforts into the development of national patient identifiers for the last two decades. The reason behind that is as the health data exchange is continuously evolving, the need for an accurate and consistent way to identify individual patient health data is becoming more demanding. Allocating a unique patient identifier to each individual in the country is one way to make sure that hospitals can share medical health records and patient health data effectively and more accurately, lack of this can lead to increased healthcare facilities costs.

Lack of communication between healthcare providers

Presently, the healthcare technology provided by today's vendors makes it tough to copy and share information from one electronic health record (EHR) software to another. Mismatched formats and data fields mean that at first data needs to be manipulated and desolated before being introduced into another system. A few different standards development organizations (SDOs) define, create, update and manage health data standards via collective processes that include health IT users but there is not any common single standard. The lack of standards for gathering, communicating, sending, storing, and managing health data is a major obstacle to healthcare interoperability.

Vendors blocking the information

Lack of shared data in healthcare is a headache. A major bottleneck to healthcare interoperability is the practice of data blocking - from the vendor's side. A study published this year highlighted that information blocking is still all over the place, and policies are ineffective to curb the practice. Though efforts to shut off information blocking are already undertaken by mandating some level of data sharing by government regulations, if efforts are successful, then slowing down information blocking will help to make sure that information follows across provider organizations, which in turn will improve efficiency and quality of care.

Difficulty with Analysis, Measurement, and Improvement of Interoperability

As one of the sayings goes you can't improve what you can't measure. Hence, it's difficult to measure the costs of error rates that occur when healthcare systems do not communicate with each other in a useful way. Due to the lack of ability to measure, or trace outcomes, health systems and other healthcare providers can't boost their important processes and this results in a lack of initiative to improve interoperability. The challenge faced by healthcare providers and their vendors is the lack of a standard way to measure the influence of interoperability problems. Once the healthcare industry can control these issues across healthcare systems, they will be able to analyze problems and make changes, and can also measure how those changes can boost the quality of care and patient outcomes.