One of the core goals of meaningful use is to exchange health information electronically, which requires interoperability between systems. Interoperability will allow hospitals and other healthcare providers to share clinical and financial data to deliver care more efficiently. "It's not too much of stretch [to say] interoperability could be the “Holy Grail” for addressing clinical and nonclinical issues in hospitals, including patient safety, billing, collections, quality measures and satisfaction of customers," says Jim St. Clair, CISM, PMP, SSGB, senior director of Interoperability and Standards at HIMSS. He notes that while interoperability is growing, it still has a long way to go. He shares eight steps hospitals and healthcare systems can take to achieve interoperability.
1. Become a "meaningful user." "The most important thing for a typical hospital or medical facility is to make sure they are working diligently to meet requirements of meaningful use stage 1 and beginning to work towards meaningful use stage 2," Mr. St. Clair says. Some of the requirements for meaningful use stage 2 call for hospitals to send data electronically to other organizations, such as transmitting prescription orders to pharmacies or laboratory results to public health agencies. Meeting meaningful use standards will thus help hospitals prepare for health information exchange and interoperability. Mr. St. Clair suggests hospitals that are not currently participating in HIEs start to get involved at the state level to become familiar with electronic information exchange.
2. Understand interoperability. While many hospitals are including interoperability in their IT strategies, the concept remains new for the industry, Mr. St. Clair says. "One of the biggest challenges is making sure everyone understands the requirements for having interoperable systems, specifically around meaningful use and what the incentive program is for adoption of electronic health records."
3. Follow industry standards. One of the keys to successful interoperability is following a set of industry-wide standards that govern how information is shared. In fact, the Office of the National Coordinator for Health IT has identified reducing optionality in health IT as a goal for supporting interoperable HIE.
Integration profiles — a collection of information exchange protocols — are one tool that can enable different technologies to communicate with one another. "Integration profiles apply part of a technical framework that allows two systems developed by two different companies to have rules and protocols to exchange information [so] when one machine says one thing, the other understands it to be what was intended," Mr. St. Clair says. Profiles and other standards are essential for interoperability because they can ensure a large number of participants in an HIE. "Interoperability is a phenomenon that can only be observed as a network effect," says Elliot B. Sloane, PhD, CCE, professor and director of Health Systems Engineering and founder, president and executive director of the Center for Healthcare Information Research and Policy at Drexel University School of Biomedical Engineering in Philadelphia. "As more systems and [physicians] are able to share information with each other, the more powerful it is. The value is multiplied by the number of participants."
4. Define the information to be exchanged. Before exchanging data, participating providers have to define what type of information they will share — whether it's clinical or nonclinical — and what they will do with the information. "One of the challenges is that each aspect of the business process requires a different type of information," Mr. St. Clair says. "First you have to come to an agreement on what types of information there are and what they mean. Then establish standards to collect information and do something usable and meaningful with it."
5. Secure data. Exchanging data between different organizations requires the data to be secure and that each participating provider understands what the security requirements are. Mr. St. Clair suggests hospitals first ensure they comply with HIPAA, and then look at requirements under the HITECH Act to also secure data.
6. Test the systems. Testing interoperability involves several different levels of testing. Healthcare organizations should first test that the software has successfully implemented the integration profiles using test data. Then, providers should test the systems as part of an HIE to ensure they can work within the HIE's specifications. Lastly, organizations should test interoperable systems as part of a configuration at a site, according to Mr. Sinclair. "Testing represents the first step in several that we have to move to in the future to truly validate interoperability needed for systems," he says.
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1. Become a "meaningful user." "The most important thing for a typical hospital or medical facility is to make sure they are working diligently to meet requirements of meaningful use stage 1 and beginning to work towards meaningful use stage 2," Mr. St. Clair says. Some of the requirements for meaningful use stage 2 call for hospitals to send data electronically to other organizations, such as transmitting prescription orders to pharmacies or laboratory results to public health agencies. Meeting meaningful use standards will thus help hospitals prepare for health information exchange and interoperability. Mr. St. Clair suggests hospitals that are not currently participating in HIEs start to get involved at the state level to become familiar with electronic information exchange.
2. Understand interoperability. While many hospitals are including interoperability in their IT strategies, the concept remains new for the industry, Mr. St. Clair says. "One of the biggest challenges is making sure everyone understands the requirements for having interoperable systems, specifically around meaningful use and what the incentive program is for adoption of electronic health records."
3. Follow industry standards. One of the keys to successful interoperability is following a set of industry-wide standards that govern how information is shared. In fact, the Office of the National Coordinator for Health IT has identified reducing optionality in health IT as a goal for supporting interoperable HIE.
Integration profiles — a collection of information exchange protocols — are one tool that can enable different technologies to communicate with one another. "Integration profiles apply part of a technical framework that allows two systems developed by two different companies to have rules and protocols to exchange information [so] when one machine says one thing, the other understands it to be what was intended," Mr. St. Clair says. Profiles and other standards are essential for interoperability because they can ensure a large number of participants in an HIE. "Interoperability is a phenomenon that can only be observed as a network effect," says Elliot B. Sloane, PhD, CCE, professor and director of Health Systems Engineering and founder, president and executive director of the Center for Healthcare Information Research and Policy at Drexel University School of Biomedical Engineering in Philadelphia. "As more systems and [physicians] are able to share information with each other, the more powerful it is. The value is multiplied by the number of participants."
4. Define the information to be exchanged. Before exchanging data, participating providers have to define what type of information they will share — whether it's clinical or nonclinical — and what they will do with the information. "One of the challenges is that each aspect of the business process requires a different type of information," Mr. St. Clair says. "First you have to come to an agreement on what types of information there are and what they mean. Then establish standards to collect information and do something usable and meaningful with it."
5. Secure data. Exchanging data between different organizations requires the data to be secure and that each participating provider understands what the security requirements are. Mr. St. Clair suggests hospitals first ensure they comply with HIPAA, and then look at requirements under the HITECH Act to also secure data.
6. Test the systems. Testing interoperability involves several different levels of testing. Healthcare organizations should first test that the software has successfully implemented the integration profiles using test data. Then, providers should test the systems as part of an HIE to ensure they can work within the HIE's specifications. Lastly, organizations should test interoperable systems as part of a configuration at a site, according to Mr. Sinclair. "Testing represents the first step in several that we have to move to in the future to truly validate interoperability needed for systems," he says.
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