How to Achieve True Interoperability in Healthcare Systems

Summary

The video script addresses the challenge of achieving interoperability in healthcare systems, distinguishing between syntactic and semantic interoperability. Syntactic focuses on the structure of data exchange, exemplified by HL7 V2 and FHIR standards, which enable systems to communicate despite different formats. Semantic interoperability, however, ensures that data has a consistent meaning across systems, avoiding discrepancies in interpretation. The script emphasizes the importance of human agreement and FHIR's machine-readable profiles in advancing towards true semantic interoperability in healthcare IT.

Takeaways

• 🔄 Achieving interoperability between healthcare systems is an ongoing challenge due to numerous digital systems across facilities.
• 🖥️ Software solutions, including InterSystems technologies, help improve interoperability between these systems.
• 🔗 There are two types of interoperability: syntactic and semantic.
• 🔧 Syntactic interoperability focuses on the structure of messages but does not interpret their meaning, allowing systems to send and receive data in different formats.
• 📤 An intermediary system can transform data between formats, such as converting HL7 V2 messages to FHIR format, to achieve syntactic interoperability.
• 🌍 HL7 V2 is the most widely used interoperability standard, with InterSystems exchanging over one billion messages daily.
• 📜 Compatibility with FHIR is federally mandated in many countries, representing the future of healthcare IT interoperability.
• 🧠 Semantic interoperability ensures that data has the same meaning across systems, reducing discrepancies caused by human interpretation.
• 🦓 Human decision-making plays a key role in interpreting nuanced data, but semantic interoperability seeks to eliminate the need for this.
• 🏥 FHIR's machine-readable profiles enable healthcare systems to share data concepts and move toward semantic interoperability if common agreements are reached.

Q & A

What is the main challenge of achieving interoperability in healthcare systems?

The main challenge is enabling communication between dozens of digital systems at a given facility and across multiple facilities within a network. These systems often use different formats and structures, making data exchange difficult.

What are the two types of interoperability mentioned in the script?

The two types of interoperability are syntactic interoperability and semantic interoperability.

What is syntactic interoperability?

Syntactic interoperability ensures that systems can send and receive data in different formats by defining the structure of a message, but it does not address the meaning of the data being exchanged.

Why is syntactic interoperability crucial for healthcare IT infrastructure?

Syntactic interoperability allows systems to exchange data using standardized formats like HL7 V2 and FHIR, which are essential for communication between different healthcare systems.

What solution is typically used to achieve syntactic interoperability between systems using different data formats?

An intermediary system that transforms data from one format to another, such as converting HL7 V2 messages into FHIR format, is commonly used to achieve syntactic interoperability.

What is semantic interoperability?

Semantic interoperability ensures that data exchanged between systems has the same meaning and can be used directly within the receiving system's workflow without needing human interpretation.

Can you provide an example that illustrates the importance of semantic interoperability?

An example involves three different electronic health record systems documenting suspected lung cancer. Each system structures the data differently, making it difficult to determine that they all refer to the same medical condition, highlighting the need for common data definitions.

Why is it difficult to achieve semantic interoperability in healthcare?

Achieving semantic interoperability is challenging because systems may define the same concept in different ways, and there must be human agreement on standard definitions to ensure consistent meaning across systems.

What is the role of FHIR in promoting interoperability?

FHIR plays a key role by making everything machine-readable, including FHIR profiles, which allows for easier sharing of data concepts across organizations, moving them closer to semantic interoperability.

What must medical networks do to achieve semantic interoperability using FHIR?

Medical networks must agree on common FHIR profiles to use in their systems, which will help standardize data definitions and bring them closer to achieving semantic interoperability.

Outlines

00:00

🔄 Achieving Syntactic and Semantic Interoperability in Healthcare

The paragraph discusses the ongoing challenge of achieving interoperability between various healthcare systems. It highlights the importance of syntactic interoperability, which involves the structure of data exchange but not its meaning, and is essential for systems to communicate effectively. The use of standards like HL7 V2 and FHIR is crucial for syntactic interoperability. However, the paragraph also emphasizes the need for semantic interoperability, where data has the same meaning across systems, eliminating the need for human interpretation and reducing discrepancies. The example of different systems describing a 'zebra' differently illustrates the challenge of achieving semantic interoperability. The FHIR standard's machine-readable nature is noted as a valuable aspect for sharing data concepts across organizations, which could help in achieving semantic interoperability.

Keywords

💡Interoperability

Interoperability refers to the ability of different systems and devices to communicate and share data effectively. In the context of the video, it is a critical challenge in healthcare systems where multiple digital systems within a facility or network need to exchange information seamlessly. The video discusses how achieving interoperability is essential for efficient patient care and data management, highlighting the importance of both syntactic and semantic interoperability.

💡Syntactic Interoperability

Syntactic interoperability is about the structure of data exchange, ensuring that systems can send and receive data in different formats. The video uses the example of System A using HL7 V2 messages and System B using a FHIR repository with JSON format to illustrate the need for an intermediary system that can transform data from one format to another. Achieving syntactic interoperability is crucial for systems to communicate effectively, as it provides a standardized way of exchanging data.

💡HL7 V2

HL7 V2 is a widely used interoperability standard in healthcare for exchanging electronic health information. The video mentions that HL7 V2 is the most used standard globally, with InterSystems technology facilitating over one billion HL7 V2 messages daily. This standard is foundational for syntactic interoperability, allowing healthcare systems to communicate despite differences in data formats.

💡FHIR

FHIR stands for Fast Healthcare Interoperability Resources and is a modern standard for healthcare data exchange. The video discusses FHIR's growing importance, noting that compatibility with FHIR is federally mandated for healthcare IT systems in many countries. FHIR's machine-readable nature, including its profiles, is highlighted as a valuable aspect for achieving semantic interoperability across different healthcare organizations.

💡Semantic Interoperability

Semantic interoperability goes beyond just the format of data exchange; it ensures that the meaning of the data is consistent across systems. The video uses the analogy of describing a zebra differently in two systems to illustrate the challenges of achieving true semantic interoperability. It emphasizes that for systems to effectively use data from other systems, there must be a shared understanding of what the data represents, which is crucial for accurate healthcare decision-making.

💡Data Transformations

Data transformations involve the process of converting data from one format to another to enable systems to communicate. The video explains how an intermediary system can transform data, such as from HL7 V2 to FHIR format, to achieve syntactic interoperability. This process is essential for bridging the gap between different data formats used by various healthcare systems.

💡Healthcare IT Infrastructure

Healthcare IT infrastructure encompasses the hardware, software, and networks that support the delivery of healthcare services. The video highlights the importance of syntactic interoperability for this infrastructure, as it is critical for systems to communicate and share patient data effectively. A robust IT infrastructure is essential for modern healthcare facilities to function efficiently.

💡Human Decision-Making

Human decision-making plays a significant role in achieving both syntactic and semantic interoperability. The video points out that engineers and other professionals must determine how to set up mappings for systems to communicate, which can lead to discrepancies if not managed properly. Human agreement on data definitions and formats is crucial for achieving semantic interoperability.

💡Data Elements

Data elements are the individual pieces of information that make up a dataset. In the context of semantic interoperability, the video emphasizes the need for data elements to be consistently defined across systems. This consistency is necessary for systems to accurately interpret and use data from other sources without requiring human interpretation.

💡Electronic Health Record Systems

Electronic Health Record (EHR) systems are digital versions of patients' paper charts and contain key clinical information about patient history, diagnoses, medications, and more. The video uses EHR systems to illustrate the complexities of achieving semantic interoperability, as different systems may model the same data differently, leading to challenges in recognizing that the data represents the same health concern.

💡Machine-Readable

Machine-readable refers to data formats that can be easily processed by computers without human intervention. The video highlights the FHIR standard's machine-readable nature as a key feature that facilitates sharing and understanding of data across different healthcare systems. This characteristic is essential for achieving semantic interoperability, as it allows for automated data exchange and interpretation.

Highlights

Achieving interoperability between healthcare systems is a constantly evolving challenge due to the variety of digital systems in medical facilities.

Interoperability can be categorized into two types: syntactic and semantic interoperability.

Syntactic interoperability allows systems to send and receive data in different formats, but does not define the meaning of the data.

HL7 V2 and FHIR are common standards that enable syntactic interoperability in healthcare.

HL7 V2 is the most widely used interoperability standard globally, with over one billion HL7 V2 messages exchanged daily.

InterSystems technologies are designed to improve interoperability between healthcare systems.

FHIR compatibility is now federally mandated for healthcare IT systems in many countries, signaling a shift toward standardization.

Syntactic interoperability alone is not sufficient; semantic interoperability is needed to ensure consistent data meaning across systems.

Semantic interoperability ensures that data from different systems has the same meaning and can be used within the workflow of the receiving system.

Discrepancies can arise when different systems define or describe the same data elements in varying ways, leading to potential miscommunication.

A real-world example involves documenting suspected lung cancer, where three different systems model the condition using different data elements.

Semantic interoperability focuses on establishing common meanings for data elements to avoid misinterpretation across systems.

A key challenge in healthcare IT is balancing efficient data schema setup for developers with accurate data entry for clinicians.

Achieving semantic interoperability is an ongoing effort requiring not just technological solutions but also human consensus.

The FHIR standard's machine-readable format and FHIR profiles help organizations share consistent data concepts, aiding in semantic interoperability.

Transcripts

Achieving interoperability between healthcare systems

is a constantly evolving challenge.

With dozens of digital systems at a given medical facility

and numerous facilities within a medical network,

the challenge of enabling systems to communicate

is significant.

Software products--including multiple InterSystems

technologies--have been built to improve interoperability

and facilitate these connections.

As we look more closely at the challenges of connecting

systems and facilities, we will distinguish

two types of interoperability: syntactic and semantic.

Syntactic interoperability--where

the structure of a message is defined,

but its meaning is not--makes it possible for systems to send

and receive data in different formats.

Without this, systems cannot communicate effectively.

For instance, System A sends and receives patient information

as HL7 V2 messages, and a patient-facing application

on System B uses a FHIR repository

with data represented in a JSON format.

As it stands, System A cannot contribute data to the FHIR

repository, and thus, the application on System B cannot

utilize that system's patient data.

A tried-and-true solution for this problem is to have

an intermediary system that transforms data from one format

to another--such as from the HL7 V2 format into the FHIR

format--via data transformations.

By creating such a mapping, we achieve

syntactic interoperability; that is, the two systems

have a standardized way of exchanging data.

The HL7 V2 and FHIR standards have paved the way

for syntactic interoperability, which

is critical to healthcare IT infrastructure.

HL7 V2 is the most used interoperability standard

in the world, with InterSystems technology

being used to exchange over one billion HL7 V2

messages each day.

And as we enter a future focused on FHIR,

consider that compatibility with the FHIR standard

is now federally mandated for healthcare IT

systems in many countries.

But syntactic interoperability, while critically important,

is not enough on its own.

Healthcare interoperability always depends

upon human decision-making; for example, an engineer

might determine how to set up a mapping for two health systems

that use different data formats to communicate.

As a result, discrepancies can arise across a chain

of mapped systems.

Achieving semantic interoperability

can help avoid some of these discrepancies.

With true semantic interoperability,

data from systems has the same meaning,

and can be used in the workflow of the receiving system.

Data elements are consistently defined,

and human interpretation is not required.

Imagine one system describing a zebra to another system.

In System A, the zebra is described as a white horse

with black stripes.

System B, meanwhile, defines a zebra

as a black horse with white stripes.

It's great that these systems can communicate clearly

with each other, and that this information can be transmitted

in an understandable language.

But how does each system know that they

are describing the same thing?

The ability to interpret nuanced language is one trait that

separates humans from machines .

Humans excel at disambiguating data like this,

and most humans could identify that the two animals described

are actually one and the same.

In the world of healthcare, there

are millions of zebras that systems need to describe,

and semantic interoperability requires an agreement

on which description to use.

Let's consider how this concept applies

to a real-world example from three

separate electronic health record systems.

Each clinician is documenting the same issue:

suspected lung cancer.

One system models this data as three different elements:

the health concern of cancer, the body site, lung,

and the status, suspected.

Another system may have a health concern of its own called

suspected cancer, leaving the body site--lung--to be

documented.

And yet another system may have suspected lung cancer

as a standalone entry for the clinician

to select as a health concern.

In the end, the data storage across the three systems

in this example would have only one element in common:

the body site of lung on systems #1 and #2.

Beyond that, there is no way for these systems

to determine, given the way this data is entered,

that the entries all mean the same thing.

Establishing common meaning is at the heart

of semantic interoperability.

As healthcare IT systems scale, the balancing act

becomes more challenging between efficient setup of data

schemas for IT developers and accurate data entry

for clinicians.

Achieving semantic interoperability will be a work

in progress for the foreseeable future that involves not just

technology, but also a certain level of human agreement--which

can go a long way.

One of the most valuable aspects of the FHIR standard

is that everything is machine-readable,

including FHIR profiles.

This makes it possible to share FHIR implementations of data

concepts across organizations.

And if medical networks can agree on the FHIR profiles

to use in their systems, they will

be one step closer to achieving semantic interoperability.