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How Health Data Standards Aid Interoperability In Healthcare

Jun 3

To achieve significant healthcare interoperability, health data standards must be adopted in a consistent and comprehensive way.

For providers, payers, and other important industry players, achieving genuine healthcare interoperability throughout the care continuum is a primary objective.

For healthcare institutions hoping to receive incentive payments under the CMS Promoting Interoperability (PI) Program, previously known as meaningful use, seamless, complete data exchange is critical.

Interoperability between enterprises and across EHR systems is enabled through the adoption and usage of health data standards.

"Standards are agreed-upon techniques for bringing systems together," according to the ONC. Security, data transit, data format or structure, or the semantics of codes or phrases may all be covered by standards."

Several distinct standards development organizations (SDOs) in the healthcare business collaborate to design, define, update, and maintain health data standards via collaborative methods that include health IT users.

While SDOs have established a number of well-known standards to encourage interoperability, current standards are less effective due to a lack of broad acceptance and application. Furthermore, variations in how developers apply data standards might stymie progress toward healthcare interoperability.

Why is interoperability such a difficult task for vendors and healthcare organizations, and how may health data standards aid in the realization of the aims of a connected care ecosystem?

INTEROPERABILITY IN HEALTHCARE: WHAT DOES IT MEAN?

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, according to HIMSS.

Interoperability is divided into four categories: fundamental, structural, semantic, and organizational.

Interoperability as a foundation

The capacity of one IT system to transfer data to another IT system is known as foundational interoperability. The receiving IT system just has to be able to confirm receipt of the data payload; it does not need to be able to comprehend the transmitted data.

Interoperability of structures

The capacity of the receiving system to comprehend data at the data field level is referred to as structural interoperability.

Interoperability in Semantics

The capacity of health IT systems to communicate and analyze information, as well as actively utilize the information provided, is known as semantic interoperability.

To enhance treatment quality, safety, and efficiency, semantic interoperability enables physicians to share patient summary information with other caregivers and authorized parties using various EHR systems.

This degree of interoperability enables healthcare institutions to communicate patient data in real time, reducing duplication of testing, enabling better-informed clinical decision-making, and preventing adverse health outcomes. Effective health data sharing may also help hospitals enhance care coordination, minimize readmissions, and save money in the long run.

Interoperability among organizations

"Governance, policy, social, legal, and organizational factors to promote the safe, frictionless, and timely exchange and use of data both inside and between organizations, entities, and people," according to HIMMS.

Despite the fact that organizational interoperability is the aim, most healthcare organizations are still trying to build basic and structural interoperability.

Existing health data standards may be used by hospitals and health systems to achieve lower levels of interoperability and provide the groundwork for future advancements in health data interchange.

WHICH HEALTH DATA STANDARDS CAN ASSIST IN IMPROVING INTEGRITY?

Standards provide a way for health IT developers, EHR suppliers, and healthcare institutions to guarantee that health IT systems and devices can properly communicate data.

Health Level 7 International (HL7) and DirectTrust are two separate industry organizations that have created standards and implementation specifications that ONC is presently responsible for curating.

The Interoperability Standards Advisory (ISA) of the government agency acknowledges a number of standards for various elements of health data sharing and interoperability.

The ONC has published the 2022 ISA Reference Guide, which includes revisions to the standards based on feedback from stakeholders and subject matter experts.

Foundational and structural interoperability is supported by three industry standards.

Architecture for Consolidated-Clinical Documents (C-CDA)

HL7, Integrating the Healthcare Environment (IHE), the Health Story Project, and ONC collaborated to create C-CDA. According to ONC, C-CDA develops clinical documents that include both human-readable language and machine-readable Extensible Markup Language (XML).

C-CDA, according to HL7, provides users with a library of templates and specifies how they should be used for various document categories.

For twelve structured document types and one unstructured document type, the standard offers a single source of clinical document architecture (CDA) templates. CDA is a document markup standard for data transmission that governs the form and semantics of clinical documents. C-CDAs are used to transfer information by health IT developers, health information exchanges (HIEs), vaccination registries, SDOs, EHR suppliers, and healthcare organizations.

To facilitate well-informed clinical decision-making, healthcare practitioners utilize C-CDAs to deliver continuity of care papers, consultation notes, diagnostic imaging results, discharge summaries, and other documents.

The final regulation for health IT certification in the 2015 Edition contains certification requirements for C-CDA implementation, usability, and quality.

Secure direct messaging

Providers may safely communicate and receive health information using direct messaging over the internet. DirectTrust, a non-profit business organization, promotes the use of the direct message standard for health data transmission. Direct, like C-CDA, is a document-based interchange system.

DirectTrust created the Direct standard, which consists of standards and protocols for direct exchange. The Direct standard was established in 2010 by the Direct Project, an ONC-sponsored public-private partnership.

DirectTrust has enabled approximately 2.9 billion direct secure communications, an average of more than 79 million transactions each month, since it started recording transactions in 2014.

DirectTrust has also developed a security and trust architecture that enables direct interaction between providers and bidirectional data sharing between patients and providers. Over 291,000 healthcare organizations are part of the network.

Interoperability Resources for Healthcare in a Hurry (FHIR)

FHIR is an HL7-developed and maintained internet-based data standard that links several discrete data pieces.

Data components, also known as resources, are given standardized, shareable IDs that work similarly to a webpage's URL. Metadata, language, and specific data items may all be used as resources, allowing for discrete data sharing rather than document-based communication.

FHIR has swiftly grown in popularity as a standard for facilitating structural – and, in some circumstances, semantic – interchange. Most major EHR companies have invested in the standard, which has helped to popularize it and establish FHIR as a dominant data exchange mechanism.

Developers may construct applications that integrate into EHR systems and transmit information directly into the provider workflow using FHIR and defined application programming interfaces (APIs).

The ONC final regulation encourages medical practitioners and health IT developers to use FHIR-based APIs and third-party applications to access patient data.

The ONC proposed to adopt the HL7 FHIR standard as a fundamental standard and asked for feedback on four possibilities in order to select which version of FHIR to adopt. Finally, ONC approved FHIR Release 4 as its standard. By December 31, 2022, the 2015 edition health IT certification standards must be updated, as well as new standardized API functionality dates.

STANDARDS ADOPTION AND IMPLEMENTATION PROBLEMS

While FHIR is a basic notion, Kristian Feterik, medical director of interoperability at the University of Pittsburgh Medical Center (UPMC), stated in a recent Healthcare Strategies podcast episode that while it is a simple concept, variety in implementation poses issues for interoperability.

"It's a transit layer," says the narrator. "The essential principles of FHIR are basically modular and have an interconnected structure," Feterik said. "However, what generally occurs is that guidelines—rather than standards—are established."

For example, each FHIR resource, such as patient demographic information or medicine orders, has 10 to 50 characteristics, according to him. However, instead of making all of those resource features mandatory, EHR suppliers choose just a few of them, which stymies data-sharing initiatives.

"If we want to improve interoperability, we actually need to agree on the needed features or attributes of a resource," Feterik said, "so that when those qualities are lacking, we can design a better means to transmit information."

HOW CAN HEALTHCARE ORGANIZATIONS IMPROVE STANDARDS APPLICATION?

To raise their degree of standardization for more full health data sharing across health systems, healthcare organizations, medical practices, and other institutions, healthcare organizations should take the following actions.

Consider using Certified EHR Technology from the 2015 Edition

Certified EHR Technology (CEHRT) 2015 Edition users have access to capabilities that improves interoperability.

EHR suppliers must verify that their product offerings match all 2015 Edition health IT certification requirements as well as the 2015 Edition basic EHR definition in order to earn ONC health IT certification in the 2015 Edition.

Through increased data export capabilities, certified health IT that meets the 2015 Edition basic EHR criteria must promote health data interchange and access.

Third-party applications must be able to connect to health IT products through an API, and systems must facilitate care transitions.

Furthermore, two 2015 Edition certification requirements demand that health IT incorporate features that support C-CDA uniformity and usability.

The health IT systems must enable users to view just the data inside a specified C-CDA section and establish a choice for the display order of certain parts, according to the transitions of care certification requirement.

Users may change C-CDA presentation to increase accessibility and prevent information overload for providers who may be overwhelmed by the volume of data accessible in C-CDAs if health IT meets certain requirements.

Furthermore, 2015 Edition certified EHRs must offer Direct Exchange capabilities.

Participate in the creation of standards

Stakeholders may provide input to the International Standards Association (ISA) and comment on interoperability standards and implementation specifications.

ISA is a set of standards for promoting interoperability in public health, health research, patient care, and healthcare administration. These standards are updated on a regular basis in order to fulfill the interoperability requirements of a diverse set of companies.

The agency provides yearly public comment sessions to enable providers, developers, and other interested parties to submit their ideas to the standards community, ensuring that industry involvement is a key component of the decision-making process.

The goal of ISA is to offer a single, public list of standards and implementation specifications that best fulfill clinical interoperability requirements.

ISA also tackles the security flaws in data standards and implementation specifications, as well as providing best practices for enhancing security.

Healthcare organizations may ensure that SDOs reflect the provider viewpoint by participating to the national discourse around healthcare interoperability standards.

Communication between healthcare organization leadership, providers, EHR suppliers, and government bodies will be critical in developing a meaningful data interchange environment that supports the delivery of high-quality care as organizations get closer to the objective of universal semantic interoperability.