Standards and Interoperability

Posted on by triciuhhh

On the previous weeks, we have discussed different ways on how to store medical records electronically. Either be stored through a Provider’s Health Information System or for personal use by the utilization of third-party PHR applications. To reiterate the goal of e-Health—be it on the local or worldwide level—is to have quality access to health care for all, and for that to be achieved, the convenience of timely access for patient’s information through Health Information Systems at any given point of care affects how different collaborating Health Care Providers (HCP) provide informed decisions and individualized care basing on accurate health information.

Due to increased number of different Health Information Systems being used by different health care facilities, it was identified that most of them are based on different data formats and structures, has incompatible operating systems, application servers, and databases. What does that mean? It means that the HIS are fragmented like isolated islands (like the Philippine archipelago, right?) and the information stored stays only within the vicinity of the facility because the system does not have the ability to share the information to another facility (for health care collaboration purposes). It lacks the functionality of interoperability.

For this week, we will be focusing on the aspect of Standards and Interoperability. Before we dive in the driving question, let us define what is interoperability? Specifically speaking in the healthcare domain, interoperability is the ability (for the lack of better term) of more than one health information system to send, receive, find, exchange and make use of the medical information in a manner that is secure, timely, accurate, and reliable. It crosses the boundaries of different organizations in order to provide effective healthcare delivery to all individuals and communities. Interoperable HIS would be helpful in terms of critical public health functions like real-time case reporting, disease surveillance, and disaster response (HealthIT.gov, 2016).

 It seems similar with the term Health Information Exchange that was discussed in one of the previous posts and may be use interchangeably. I believe it is important to emphasize that those two terms are different. HIE is more of exchange and transport of the information and is part of the bigger concept of HI interoperability. According to a research from South African Computer Journal, HI interoperability has a full sets of standards as enumerated below:

  1. Interoperability framework and architecture
  2. Identified standards
  3. Messaging or Information Exchange Standards (See? HIE is just a part of interoperability!)
  4. Structure and content standards
  5. Clinical Terminology and Coding Standards
  6. EHR Standards
  7. System Functional Models
  8. Security and Access Control Standards

In relation to the driving question, how can healthcare institutions adopt standards to ensure interoperability? I think it would be more effective if the business or the framework model to be used in developing the health information system will definitely cover intensively all the system requirements that will solve the identified problems. On the national level, the existing framework we have for the country is the following:

  • Governance and management bodies to oversee the implementation of the health information or e-health in the country.
  • Strategy on uniting the existing different Health Information System Platforms with the use of Health Information Exchange.
  • Investment and allocation of budget for the infrastructures and maintenance
  • Legislation and Policy
  • Workforce – skilled and qualified health and technical staff to implement the e-health initiatives and interoperability strategies of the  HIS.
  • Standards – HIS interoperability has full sets of standards I have mentioned below but specifically, I would like to discuss Clinical Terminology and Coding Standards—with wide range of codes to be used, it should be identified which ones to be used in properly tagging or classifying the terms. This is for the purpose of being very specific and due to wide range of terms being used in the medical field, it is very much important to be clear, accurate and precise because this will be the data will be used or based for clinical decision. There are different Clinical Terminologies and Coding Standards being used by Health Information Systems such as:
  1. ICD-10 codes – these are used for classification of diseases, health conditions, and causes of deaths.
  2. Anatomical Therapeutic Chemical Classification Systems with Defined Daily Doses (ATC/DDD) – these are used for the classification of medicines.
  3. Statistical Data and Metadata Exchange Health Domain (SDMX-HD)
  4. Systematized Nomenclature of Medicine Clinical Terms (SNOMED-CT) – coding system for medical terminologies; this can be mapped in tandem with ICD-10 codes
  5. The Logical Observation Identifiers Names and Coders (LOINC) – a coding system for laboratory results clinical observation reports.
  6. Digital Imaging and Communication in Medicine (DICOM) – this in used in the exchange of digital medical diagnostic images
  • Furthermore, the HIS to be developed should now be certified and audited by certifying bodies to comply with the established standards.

References:

  1. Mead CN. Data interchange standards in healthcare IT – computable semantic interoperability: now possible but still difficult, do we really need a better mousetrap? J Healthcare Information Management 2006. http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.136.8758&rep=rep1&type=pdf
  2. Kanter AS et al. The importance of using open source technologies and common standards for interoperability within eHealth: Perspectives from the Millennium Villages Project. Adv Health Care Manage 2012;12:189-204.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3702267/
  3. Reynolds CJ and Wyatt JC. Open source, open standards and healthcare information systems. J Med Internet Res 2011 Jan-Mar 13(1):e24 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221346/
  4. Adebesin F et al. A review of interoperability standards in eHealth and imperatives for their adoption in Africa. SACJ 2013.http://researchspace.csir.co.za/dspace/bitstream/10204/6950/1/Adebesin1_2013.pdf
  5. HealthIT.gov (2016). https://www.healthit.gov/sites/default/files/hie-interoperability/nationwide-interoperability-roadmap-final-version-1.0.pdf

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