Navigating the world of standards, interoperability and data exchange in healthcare: but first, the basics
FHIR, HL7, interoperability, data exchange ... When we're talking about transforming healthcare, these are terms that you've probably seen before. But what are standards, actually? And why do we need to strive for true interoperability? Let's bring it back to the basics! In this article, we give you an overview of the key concepts involved in the development of standards, interoperability and data exchange in healthcare.
"Standards" in healthcare
By definition, standards in the context of healthcare are explicit statements of expected quality in the performance of a healthcare-related activity. Standards communicate expectations for how a particular healthcare activity will be performed in order to achieve desired results by defining quality and standards of and towards success. These standards could have various contextual usages - from procedures to clinical practice guidelines, treatment protocols to expected health care outcomes, and in the communication and transmission of key data as we head towards deeper technological enablement within healthcare.
To achieve expected outcomes, standards must be developed in such a way that they are:
- Realistic - the standards can be followed or achieved with current resources and abilities
- Reliable - Following the standards leads to standardized outcomes (all factors being equal)
- Valid - The standards are based on scientific evidence or other acceptable experience
- Clear - The standards are understood in the same way by everyone concerned and are not subject to distortion or misinterpretation
- Measurable - Performance according to the standards may be assessed and quantified
Standards and interoperability
By establishing a series of ground rules that define standards within healthcare, the next step is towards establishing these in an explicit manner in the enablement of healthcare interoperability. Health data exchange architectures, application interfaces and standards enable data to be accessed and shared standardized and securely across the complete spectrum of care, within all applicable settings and with relevant stakeholders – keeping the healthcare provider and, most importantly, the patient in mind.
This achieves interoperability, i.e. 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, and eventually regional and national boundaries – to provide timely and seamless portability of information and optimize the health of individuals and populations globally.
According to HIMSS (Healthcare Information and Management Systems Society), there are four levels of interoperability:
- Foundational: Establishes the inter-connectivity requirements needed for one system or application to securely communicate data to, and receive data from another
- Structural: Defines the format, syntax and organization of data exchange including at the data field level for interpretation
- Semantic: Provides for common underlying models and codification of the data including the use of data elements with standardized definitions from publicly available value sets and coding vocabularies, providing shared understanding and meaning to the user
- Organizational: Includes governance, policy, social, legal and organizational considerations to facilitate the secure, seamless and timely communication and use of data both within and between organizations, entities and individuals. These components enable shared consent, trust and integrated end-user processes and workflows.
While organizational interoperability is the goal, most healthcare organizations are still navigating the foundational and structural levels.
Standards supporting Foundational and structural interoperability
Consolidated-Clinical Document Architecture (C-CDA)
C-CDA was developed by HL7, Integrating the Healthcare Environment (IHE), the Health Story Project, and ONC. C-CDA creates clinical documents that contain both human-readable text and machine-readable Extensible Markup Language (XML), according to ONC. According to HL7, C-CDA offers users a library of templates and prescribes their use for specific document types.
The standard provides a single source of clinical document architecture (CDA) templates for twelve structured document types and one unstructured document type. CDA is a document markup standard that specifies the structure and semantics of clinical documents for data exchange. Health IT developers, health information exchanges (HIEs), immunization registries, SDOs, EHR vendors, and healthcare organizations use C-CDAs to share information.
Healthcare providers use C-CDAs to send continuity of care documents, consultation notes, diagnostic imaging reports, discharge summaries, and other documents to enable well-informed clinical decision-making.
Direct secure messaging
Direct messaging allows providers to send and receive health information over the internet securely. DirectTrust, a collaborative, non-profit industry alliance, supports health data exchange using the direct message standard. Like C-CDA, Direct is a form of document-based exchange.
DirectTrust built direct exchange using specifications and protocols called the Direct standard. An ONC-sponsored public-private collaboration called the Direct Project developed the Direct standard in 2010.
Since DirectTrust began tracking transactions in 2014, the organization has facilitated nearly 2.9 billion direct secure messages – an average of more than 79 million transactions per month.
DirectTrust has also created a security and trust framework that supports provider-to-provider Direct exchange and bidirectional data exchange between patients and providers. The network includes over 291,000 healthcare organizations.
Fast Healthcare Interoperability Resources (FHIR)
FHIR is a standard describing data format and resources and an API for exchanging Electronic Health Records (EHR). Data elements, or resources, are assigned standardized, shareable identifiers that function like the URL of a webpage. Resources can include metadata, text, or particular data elements, enabling discrete, element-based data sharing rather than document-based exchange. Since FHIR was originally launched, it has been used by healthcare application implementers across the globe, including the payer community, drawn by its ease of use.
Because FHIR is implemented on top of the HTTPS (HTTP Secure) protocol, FHIR resources can be retrieved and parsed by analytics platforms for real-time data gathering. In this concept, healthcare organizations would be able to gather real-time data from specified resource models.
Benefits of interoperability: An overview
The benefits of interoperability are applicable to the healthcare industry as a whole, in an ecosystem spreading from provider to patient, impacting resources, efficiency, quick authorisations and smart, clinical decision-making.
1. Optimizing use of resources within a healthcare organization
Interoperability and automated data exchange allow for real time data access without a “nurse in between” when it comes to specific manual paperwork which total millions of hours across global providers; and encourage objective, data-led clinical decision focus making for physicians thereby reducing non value-add resource utilization for qualified staff, already under 30% shortage and strain.
A redistribution of resources has an impact at various levels for the provider, potentially allowing room for more concentrate or simply additional patient care, driving profits and innovation for the provider and faster healthcare access to patients, with wait times for certain appointments and procedures currently being calculated in months. Today, one out of every three healthcare dollars is spent on administrative costs. The industry is already benefiting from initial RPA and related early automation that require time-consuming, error-prone manual work.
Healthcare data sharing between various health systems, payers and providers improves not only the quality of care but also the efficiency in which it’s delivered.
2. Improving the quality of care and patient experience
Health systems aren’t just embracing interoperability to pander to regulatory requirements or with a profit-centric approach.
To drive value-based patient care, interoperability and healthcare data sharing have become critical for improving patient outcomes and delivering effective healthcare. With access to real-time patient data, clinicians have a more holistic view of patients, can avoid medical errors, engage in, deliver seamless care collaborations and more.
3. Protecting patient data security
Today’s healthcare interoperability solutions leverage HIPAA-compliant environments that ensure data is shared appropriately and securely. A compulsory requirement within healthcare in the U.S. pertaining to compliance is SOC 2 compliance. SOC 2 defines criteria for managing customer data based on five “trust service principles”: security, availability, processing integrity, confidentiality and privacy. SOC 2 reports are unique to each organization. In line with specific business practices, each designs its own controls to comply with one or more of the trust principles and are two types of reports: Type I which describes a vendor’s systems and whether their design is suitable to meet relevant trust principles; and Type II that details the operational effectiveness of those systems.
Bear in mind the fundamentals behind security and compliance – the fewer healthcare workers who manually update patient data, the less chance there is of exposure to security threats.
The way healthcare is delivered is changing. The shift to digital is considered positive to prepare healthcare for future challenges, but it can also be a complex endeavor. With the Founda Health Platform we strive to enable new and innovative collaboration models that all partners benefit from. Want to learn more about how we do that?