Semantic interoperability represents the pinnacle of machine-to-machine communication, enabling disparate IT systems to share data in a useful way.
In the healthcare sector, semantic interoperability is critical for bridging the terminology gap among divergent health IT (HIT) systems and data sources. This capability aims to create a common vocabulary that will provide accurate and reliable communication among computers.
Lower-level technical interoperability is already a common feature among healthcare enterprises. The Health Level 7 (HL7) series of standards, for example, provides guidance on how messages should be structured. But HL7 doesn’t speak to the content of those messages. While a doctor knows that dropsy describes the same illness as congestive heart failure, a computer typically can’t make that distinction. That’s where semantic interoperability comes in, providing a mechanism that allows HIT systems to not only acquire data but interpret its meaning.
Semantic interoperability has general applicability in healthcare, where IT systems have evolved in isolation amid localized and proprietary terminologies. But there are a few specific industry developments that make the capability particularly critical in 2015 and beyond. Consider the following:
Meaningful Use Timelines
Semantic interoperability can help a healthcare provider meet the federal government's Meaningful Use program criteria. Compliance is particularly important for providers seeking to comply with Stage 2 Meaningful Use. For example, Stage 2 makes RxNorm a required vocabulary for communicating medication data. But many organizations will first need to map their current pharmacy management codes to RxNorm. The semantic capability will make the mapping process much faster than manual interpretation, enabling computers to make the translation from local to standard coding formats automatically. In addition, industry standard LOINC codes are required under the Meaningful Use program. To qualify for Meaningful Use incentives, a provider must translate its proprietary lab codes to LOINC. Semantic interoperability will help such organizations sort out laboratory information systems transactions.
Stage 2 Meaningful Use compliance next year will have special significance for providers who began the program in 2013: the incentive payment for Medicare providers who demonstrate a full year of compliance in 2015 will be $8,000. To see where you stand, visit the CMS website’s participation timeline. But 2015 isn’t only important from an incentive standpoint. Medicare eligible professionals who haven’t achieved Meaningful Use compliance will be subject to penalties in the form of payment adjustments starting on January 1, 2015.
A semantically normalized information model is considered central to the success of forward-thinking healthcare initiatives and delivery models such as Accountable Care Organizations (ACOs). ACOs typically need to aggregate and work with both claims and clinical information and semantic interoperability can help those organizations build a normalized data foundation on which to build a business. ACOs that signed contracts under the Medicare Shared Savings Program have three years to get their financial and care delivery acts together. Organizations that meet certain cost and quality benchmarks qualify for shared savings. But ACOs may also end up sharing in financial losses, depending on the contractual model. The first batch of 3-year Medicare Shared Saving Program ACO contracts will expire in 2015, with the second class of program participants to follow in 2016.
The ongoing ICD-10 conversion calls for semantic interoperability as healthcare organizations seek to leverage the increased specificity over ICD-9 for reporting and analytics purposes. That work will enter a crucial stage next year: The Department of Health and Human Services has set a October 1, 2015 deadline for ICD-10 adoption.
Healthcare faces a highly complex IT environment for achieving semantic interoperability, in particular between providers and health plans pursuing high-profile healthcare initiatives that rely on the ability to successfully exchange data.
Semantic interoperability, aided by data normalization solutions and automated mapping, can make life easier for healthcare providers focused on deadline-driven programs.
How might this ability apply to your key data projects in the next few years? Leave your comments below.