Understanding Healthcare Interoperability
Healthcare interoperability is the ability to transmit and receive healthcare data as needed in a frictionless and secure manner between healthcare participants. Also nicknamed “interop“, Tenasol, as a regular part of its operations is heavily involved in this process.
Depiction of healthcare interoperability
Before we get started, a few points about healthcare interoperability:
It is harder than you might think. The majority of the US healthcare system was, and still is operating on fax machines well into the 21st century. The reason is the healthcare industry lags other industries because change is risky and expensive. Compound this with the level of security required to transfer healthcare data, previous lack of solid data standards, and the nature of the electronic medical record (EMR) industry which historically has not benefited from exchanging information with competing EMRs as to retain market share.
It directly benefits patients in SO many ways. Information on a patient is critical to treatment. Take the simple example of a drug allergy, which a practitioner may not know about unless they have seen a patients medical history from past hospitals.
There are several ways to connect. Beyond direct connections, there are national networks for health data, there are EMR-direct networks, and there are state HIE direct networks. We’ll cover these in detail.
The federal government is highly incentivizing it. In addition to strong incentives pushing HL7 FHIR which heavily streamlines healthcare interoperability, federal programs are either mandating, or strongly encouraging connectivity between facilities.
Healthcare Interoperability Examples
A practitioner seeks medical records from another facility or specialist.
A lab sends results to a patient facility.
A health plan seeks patient medical data to approve a prior authorization of a drug for payment approval and dispensing.
The US government seeks medical records as evidence of disability for social security benefits of a citizen.
How Does Healthcare Interoperability Happen?
The ingredients of healthcare interoperability include:
Two entities who want to transfer data.
A data standard that both parties agree the data will be formatted in (HL7 ADT, HL7 CDA, or HL7 FHIR are common).
A method of transfer to pass the data (API or SFTP are common)
A security standard by which both parties agree the data will be encrypted (TLS over HTTPS, mTLS, or OAuth 2.0 are common)
Below is a diagram of healthcare interoperability today. Note that the receiving entity nor sender do not need to be an electronic medical record (EMR) - they could simply already be housing a warehouse of medical data in an exchangeable format. Note that EMR systems do not natively store in exchange formats, but rather export to them for exchange.
How medical data is passed depends on who is transmitting and who is receiving
Levels of Healthcare Interoperability
As defined by HIMSS, not all connections are equal. This is also shown above by the colored exchange methods.
Foundational (Level 1): A system or application can securely communicate data to and receive data from another. (e.g., Fax)
Structural (Level 2): Defined format, syntax and organization of data exchange including at the data field level for interpretation. (e.g. HL7 ADT, HL7 CDA, HL7 FHIR).
Semantic (Level 3): 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 (e.g. HL7 FHIR USCDI v3, L7 CDA C-CDA using defined coding systems)
Organizational (Level 4): 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. (e.g. full EMR integration)
Current State of Healthcare Interoperability
Faxing is still common. While HL7 C-CDA and HL7 FHIR data formats are on the rise for interoperability, fax exchange remains present as an option for all facilities as it is the simplest from a technology perspective, and nearly fail-proof in most situations.
EMR systems are highly incentivized by the federal government by reduced reimbursements for Medicare and Medicaid operations for those without an electronic medical record in place. Because certified EMR systems are required to have interoperability features, this further pushes healthcare interoperability modernization. This however does not mean facilities have to be using them for interoperability.
Integration is growing, but still low - the below study was conducted for lagged years during 2023 - you can see that system integrations are still quite low even at current trends leaving lots of room for improvement.
Importance of API Technology in Healthcare Interoperability
Application Program Interfaces (API) are the standardized method by which computers communicate over the internet at present. Healthcare interoperability implementations increasing make use of these in interfaces for integration.
Though not originally implied for it, the exchange of HL7 C-CDA medical data has increasingly been performed via API. To do so, it usually requires a standardized specification. HL7 FHIR was created with API data exchange in mind. See HAPI FHIR for a relatively popular open source Java implementation for API FHIR data exchange.
Importance of Healthcare Interoperability Networks
While it is possible for individual facilities to connect directly and singularly to each other, it is not common as it requires a legal agreement directly between the two of them. Rather than create (n choose 2) combinations of legal agreements we have seen the rise of 3 types of “Healthcare Interoperability Networks“:
Nationwide: These government subsidized, pay-to-play healthcare interoperability networks are bi-fricated based on use case for the exchange of data. To work with them, a facility must meet specific business rules such as having a need, being HIPAA compliant, and in most but not all cases having SOC 2 or HITRUST certifications. Examples of Nationwide Healthcare Interoperability Networks include:
Carequality: Started in 2016 it is a more flexible healthcare interoperability network relying on private-sector participation.
TEFCA: Finalized in 2022 and operated by the Office of National Coordinator for Health IT (ONC), TEFCA far more narrowly sets rules and regulations, while offering wider use cases and data sharing methodologies.
Both have significant overlap and more than likely one will end up being the long-term solution to a government healthcare interoperability network.
EMR-Direct: The federal government (ONC) requires that major, certified electronic medical record systems (EMRs) offer network connectivity for data exchange, either via HL7 FHIR USCDI or HL7 CDA C-CDA. It is possible to directly connect to one of these EMR networks directly.
State-Direct Health Information Exchange (HIE): These healthcare interoperability networks are somewhat, inconsistent, all over the place, and usually work with nationwide network. They suffer from fewer resources to keep up with Nationwide networks but for immediate local needs they suffice.
Tenasol and Healthcare Interoperability
Despite frameworks like TEFCA mandating seamless data sharing, once data is exchanged, it must still be parsed, linked to the correct patients, and normalized before it can be effectively applied to various use cases.
Tenasol offers innovative solutions to perform these processes, designed to ingest diverse healthcare data formats including HL7 ADT, HL7 C-CDA, and HL7 FHIR, delivering value for multiple programs. Our solutions also eliminate the need for our clients to invest in costly infrastructure to connect with EHR systems, as we provide comprehensive data connectivity capabilities on their behalf. Contact us for more details.
Conclusion
Healthcare interoperability plays a vital role in improving patient care by enabling seamless and secure data exchange between healthcare providers, payers, and government entities. While challenges such as outdated technology and security concerns persist, the push for standardized data formats like HL7 FHIR and federal incentives have accelerated progress. Healthcare interoperability networks—nationwide, EMR-direct, and state HIE networks—offer different models for facilitating data exchange. As these systems evolve, they will continue to bridge gaps, making healthcare data more accessible, improving treatment accuracy, and ultimately benefiting patient outcomes across the industry.
To learn more about how Tenasol can serve your interop needs, reach out to our team!