Interoperability and Health Information Exchange

While it is true the words interoperability and health information exchange go together, a common misconception about interoperability is that it means health information exchange (HIE).

In an ideal scenario, one does not exist without the other, but it is important to underline the fact the two terms do not refer to the same thing.

They are used interchangeably at times, even in high level discussions, but interoperability simply refers to the ability of two or more systems or components to exchange information and use it, not the entire act of the exchange.

An exchange of information is necessary for interoperability to occur, but it is not the only part of interoperability.

Interoperability vs HIE

Health information can be exchanged through a number of channels.

A doctor can send another provider an email to simply relay information, but interoperability and how it applies to electronic health records (EHRs) goes beyond the mere exchange of information. The ability of interoperable health record systems to understand and convey information gleaned from EHRs can prevent unforeseen issues.

If a doctor inputs a report from an office visit into a patient’s EHR and sends it to another system where the patient’s EHRs are kept, an example of interoperability would be the receiving system’s ability to understand the vocabulary and terminology in the initial report to then alert the doctor about medication the patient may have an allergy to or prevent redundancies in treatment.

Understanding HIE

Health information is exchanged in three primary ways. In each, interoperability plays an important role in the process of refining patient care to make it more personalized and efficient. They are:

  • Direct Exchange: Protected information is exchanged between different healthcare professionals.
  • Consumer Mediated Exchange: Patients maintain control over personal health information.
  • Query-based Exchange: Gives providers the ability to search for information about patients from other healthcare professionals.

For these exchanges to take place, the systems across which the information exchange occurs must be able to communicate. If their interoperability is insufficient, the result can resemble someone who only speaks English attempting to read something in Spanish. Some information may be gained, but important parts will likely be lost in translation.

Standards and Interoperability Framework

Different disciplines within healthcare have different uses for the information within EHRs. As a result, the modernization of healthcare records requires giving those searching that sort of information certain standards and specifications to abide by.

The task of creating a structured framework for that to take place has fallen to the Office of the National Coordinator for Health Information Technology (ONC).

The ONC’s Office of Science & Technology is currently working to develop standardized healthcare vocabularies, protocols for secure email exchanges, encryption standards to protect data, services provided by application interfaces for EHR users and the structure in which all of this information exists.

The framework, also known as Standards and Interoperability (S&I) Framework, is focused on developing clinically oriented user stories, mechanisms for feedback and testing, the creation of interoperability procedures and guidance for implementing them.

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