Three levels of health information technology interoperability

Interoperability is a complex concept involving multiple regulations, standards, vocabularies, software, hardware and users which oftentimes are spread out over geographic regions and companies taking part in caring for a LTPAC patient. For this reason, it is essential that a system, or systems, are designed in such a way that they support and enable meaningful data to flow accurately and securely from Point A to Point B without any obstacles. However, before understanding the more complex concepts of interoperability, it is vital to understand the levels of interoperability and how they relate to one another. There are three levels of health information technology interoperability: foundational, structural, and semantic. This article will discuss the first two types: structural and foundational

Foundational

This is the lowest and most basic level of interoperability. According to HIMMS, this level “allows data exchange from one information technology system to be received by another and does not require the ability for the receiving information technology system to interpret the data.”

For example, a laboratory could securely send test results in PDF format to a nurse at an LTPAC facility. The nurse would have the correct information, but would have to first open the message, download the attachment, print it, read the document and interpret it, and contact the other members of the care team to provide them the information. Based on their feedback, the nurse, if needed, would have to manually enter the information into the patient’s record. Not only is this slow, but there are multiple opportunities for human and process errors.

Structural

This is the intermediate level of interoperability in that according to HIMMS, “defines the structure or format of data exchange (i.e., the message format standards) where there is uniform movement of healthcare data from one system to another such that the clinical or operational purpose and meaning of the data is preserved and unaltered. Structural interoperability defines the syntax of the data exchange. It ensures that data exchanges between information technology systems can be interpreted at the data field level.”

For example, a patient complains to his attending physician about his knee. The doctor examines the knee and refers the patient to a specialist- an orthopedic surgeon. The orthopedic surgeon wishes to know more about the primary care doctor’s initial findings. Assuming that both physicians use software systems that supports messaging standards, then the attending physician would be able to transmit specific data elements such as “Main Complaint” and “Findings” through “pipes” that connect the two systems to one another. The receiving system would be able to quickly identify these fields in the message, retrieve the information, populate it into their system and present it to the surgeon.

While these two levels of interoperability allow healthcare providers to communicate quicker and more efficiently than by postal mail, there is yet another level of interoperability (semantic) that will be discussed in our next article that will further explain how the highest level of interoperability allows for better coordination and streamlining of care and reporting in the LTPAC industry.

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