Health Language Blog

Understand the Three Levels of Interoperability

Posted on 11/12/14

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Healthcare may have been among the last industries to automate, but the sector has made up for lost time.

Indeed, electronic data and healthcare IT (HIT) systems have expanded rapidly in recent years. But technical innovation has developed in isolated pockets. The first wave of HIT development took place in the billing and claims departments. Localized development of ancillary clinical systems such as laboratory, radiology, and pharmacy followed the rollout of administrative systems. More recently, the healthcare industry’s focus has shifted to electronic health record (EHR) systems.

Those various healthcare systems, for the most part, have evolved independently of one another and continue to exist, for the most part, as islands of automation. Understandably, communication ranks among the most pressing technology issues the healthcare community faces today. Bridging the communications gap has become hugely important. As healthcare institutions continue to launch systems to improve patient outcomes and bolster operational efficiencies, the need for those systems to communicate will only grow. In addition, communication is central to emerging healthcare business and care delivery models. Accountable care organizations (ACOs) and patient-centered medical homes (PCMHs), for instance, depend on the ability to share data among primary care physicians, specialists, hospitals and payers.

Interoperability is the technology anecdote for the lack of communication among disparate systems. This field encompasses multiple tiers of communication that healthcare managers need to understand.

What is Interoperability?

The Healthcare Information and Management Systems Society (HIMSS) has developed a definition of interoperability, which the organization describes as “the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.”

HIMSS asserts that data exchange schema and standards should allow for the sharing of data among healthcare community participants irrespective of which applications or vendors they use. Interoperability, according to HIMSS, enables HIT systems to transcend organizational boundaries and promote effective healthcare delivery.

Foundational Interoperability

The HIMSS interoperability definition is set forth in a three-tiered model. The first layer is foundational interoperability. In this layer, interoperability lets the data transmitted by one HIT system to be received by another. This tier, however, does not require the system on the receiving end of the transmission to interpret the data.  One can think of foundational interoperability as serving as the base of a communications pyramid, offering the most basic of data exchange services.

Structural Interoperability

As the middle layer, structural interoperability defines the format of the data exchange that takes place between systems. This level basically focuses on the packaging of the data via message format standards. Specifically, structural interoperability defines the syntax of the data exchange, according to HIMSS. Messaging standards such as Health Level 7, for example, provide guidance on how messages should be structured.

HIMSS notes that this form of interoperability, which is also known as syntactic or technical interoperability, permits the “uniform movement” of health data from system to system where the “clinical or operational purposes and meaning of the data is preserved and unaltered.”

But since the content of a structured message may not be standardized, higher levels of understanding between systems is typically impossible.

Semantic Interoperability

Semantic Interoperability resides at the top of the communications pyramid. HIMSS defines this layer of interoperability as the ability of systems to both exchange and use the information that has been transmitted. In this case, the structured message contains standardized, coded data. This allows the receiving HIT system to interpret the data.

In the healthcare sector, semantic interoperability is critical for bridging the terminology gap among divergent HIT systems and data sources. This capability aims to create a common vocabulary that enables accurate and reliable machine-to-machine communication.

Data normalization is seen as foundational for semantic interoperability. The scattered, isolated HIT systems that have evolved over the years employ a range of medical terminologies. The lack of standardization among terminologies represents a key barrier to semantic interoperability. Data normalization, however, offers the ability to map between different terminologies and conflicting standards. A data normalization solution allows for apples-to-apples comparisons of information from different systems by 1) standardizing local content to terminology standards and 2) semantically translating data between standards to eliminate any ambiguity of meaning.  

Breaking the Barriers

Data normalization and semantic interoperability can help healthcare organizations break down the barriers that block meaningful communication among HIT systems. What are your key interoperability issues? Leave your comments below.

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Topics: semantic interoperability, interoperability

About the Author

Dr. Brian Levy, MD is Vice President and Chief Medical Officer with Health Language, part of Wolters Kluwer Health. He holds an MD and BS from the University of Michigan. Go Blue!