Interoperability

Foundational Curriculum: Cluster 6: System Connectivity

Module 10: Interoperability, Interfaces and Integration of eHealthUnit 1: Interoperability

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Curriculum Developers: Angelique Blake, Rachelle Blake, Pauliina Hulkkonen, Sonja Huotari, Milla Jauhiainen, Johanna Tolonen, and

Alpo Vӓrri

Unit Objectives

• Identify the difference between semantic and syntactic interoperability and the role each plays in overall interoperability

• Describe the concepts of interoperability in healthcare

• Describe how interoperability works between health IT/eHealth and related information systems, applications, programs, devices and tools

This work is produced by the EU*US eHealth Work Project. This project has received funding from the European Union’s Horizon 2020 research and

innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Interoperability and Health Records

• Interoperability, in terms of healthcare, is the communication between different hospital systems in order to exchange health data, such as health records, in a useful way

• The graphic on the right shows the common areas where health data is exchanged in interoperable systems

This work is produced by the EU*US eHealth Work Project. This project has received funding from the European Union’s Horizon 2020 research and

innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Interoperability

Primary Care

Specialists

Hospitals

Pharmacies

Labs

Public Health

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Interoperability and Health Records (Cont’d)

• It is easier to send electronic data for consultation or get access if the patient enters another electronically enabled hospital, interoperable clinic or healthcare facility – Ideally, information is

independent of time and place of care delivery

– Information can be updated by building upon records, rather than storing a new paper with every new encounter

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innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Levels of Interoperability

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innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Organizational Interoperability

Semantic Interoperability

Syntactic Interoperability

Foundational Interoperability

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Levels of Interoperability (cont’d)

• There are four levels of interoperability found in HIT: foundational, syntactical, semantic and operational– Foundational interoperability:, the first level of

interoperability, foundational, or technical, interoperability allows basic technical end-to-end data exchange from one information technology system to another

• The receiving IT system may or may not be able to interpret the data

• A good example is a scanned document that a nurse would need to interpret.

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innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Levels of Interoperability (cont’d)

Foundational interoperability exampleThis work is produced by the EU*US eHealth Work Project. This project has

received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 727552

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Levels of Interoperability (cont’d)• Syntactic interoperability: the second level of interoperability, refers

to the packaging and transmission of data– Literally, syntactic comes from syntax, which is defined as “structure”

and refers to the composition of the data– Syntactic interoperability defines the structure or format of data

exchange and is achieved through tools such as XML or SQL– It is the first stage of real interoperability– It is the pre-requisite of semantic interoperability– In healthcare data, syntactic interoperability refers to standardization

related to data formats and transmission from one application to another

– In this level, there is s a uniform movement of healthcare data from one system to another so that the clinical or operational data’s meaning is preserve

– Structural interoperability preserves the syntax of the data exchange, so that data exchanges between information technology systems can be interpreted easily by the receiving IT system.

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innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Levels of Interoperability (cont’d)

Syntactic interoperability exampleThis work is produced by the EU*US eHealth Work Project. This project has

received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 727552

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Levels of Interoperability (cont’d)• Semantic interoperability: the third level of interoperability, semantic

interoperability refers to the ability of computer systems to exchange data unambiguously

– It is the ability of two or more systems to exchange information and to use the information efficiently– Semantic interoperability takes advantage of both the structuring of the data exchange and the

codification of the data so that the receiving information technology systems can interpret the data. This level of interoperability supports the electronic exchange of patient summary information among caregivers and other authorized parties via potentially disparate EHR systems effectively

– Literally, semantic is defined as “meaning”, and refers to the definition of the data– Semantic interoperability ensures that disparate HIT systems can exchange information in a

useful way. This relates to the message content, not just the message format.– This kind of interoperability relies on codified standards to allow systems to exchange,

interpret, and use information. HL7 standards for messaging, LOINC standards for laboratory vocabulary, and SNOMED standards for medical practice vocabulary are all standards that serve interoperability in the healthcare domain

– Semantic interoperability is the gold standard; however, it is difficult to achieve and requires the cooperation and collaboration of many stakeholders

– Semantic interoperability is achieved when the information transferred has, in its communicated form, all of the meaning required for the receiving system to interpret it correctly, even when the algorithms used by the receiving system are unknown to the sending system

• e.g., international patient summary record

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innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Levels of Interoperability (cont’d)

Semantic interoperability exampleThis work is produced by the EU*US eHealth Work Project. This project has

received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 727552

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Levels of Interoperability (cont’d)• Operational interoperability: the fourth level of interoperability,

operational, or pragmatic, interoperability refers to the business process integration of interoperability beyond the boundaries of a single organization– According to the model proposed by Petty and Weisel and the Virginia

Modeling, Analysis and Simulation Center (VMASC), the achievement of full interoperability is the goal of organizations with a pragmatic approach

– In a healthcare setting, organizations usually wish to attain pragmatic (realistic) interoperability or above

– Enabling the interoperability between applications requires agreement in the format and meaning (syntax and semantics) of exchanged data including the ordering of message exchanges

– However, today’s researchers argue that these are not enough to achieve a complete, effective and meaningful collaboration – the use of data (pragmatics) is important as well

– Pragmatic interoperability requires mutual understanding in the use of data between collaborating systems

– Three important steps are needed to achieve operational interoperability: foundational, syntactic and semantic interoperability

This work is produced by the EU*US eHealth Work Project. This project has received funding from the European Union’s Horizon 2020 research and

innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Levels of Interoperability (cont’d)

Operational interoperability exampleThis work is produced by the EU*US eHealth Work Project. This project has

received funding from the European Union’s Horizon 2020 research and innovation programme under Grant Agreement No. 727552

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Interoperability

Foundational/System

Syntactic/Schematic

Semantic/Content

Operational/Pragmatic

Five Steps Toward InteroperabilityThere are five steps that system developers, organizations and providers can take to progress toward interoperability in HIT:

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innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Common-open

technology platform

Common standard

engineering

Common standard

piloting/testing

Standard implementation

Industry-community

partnerships

Five Steps Toward Interoperability (Cont’d)

Step One:

Industry-Community Partnerships

– These partnerships sponsor standard workgroups with the purpose to define a common standard that may be used to allow software systems to intercommunicate for a defined purpose

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innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Five Steps Toward Interoperability (Cont’d)

Step Two:

Common Open-Technology Platform

– Using a common technology platform, coupled with open source, may speed up and reduce complexity of interoperability, reducing variability, allowing them to intercommunicate more readily

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innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Five Steps Toward Interoperability (Cont’d)

Step Three:

Common Standard Engineering

– Developers design software with the common standard, with the specific intention of achieving interoperability with other similar software, such as EHRs, also following the same standard

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innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Five Steps Toward Interoperability (Cont’d)

Step Four:

Common standard piloting/testing

– Systems produced to a common standard rely on clarity of the standards. This requires that systems are formally tested and piloted in a production scenario to ensure they will intercommunicate

This work is produced by the EU*US eHealth Work Project. This project has received funding from the European Union’s Horizon 2020 research and

innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Five Steps Toward Interoperability (Cont’d)

Step Five:

Standard implementation

– Software interoperability requires a common agreement that is normally arrived at via an industrial, national or international standards

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innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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Unit Review Checklist

Identified the difference between semantic and syntactic interoperability and the role each plays in overall interoperability (KB03)

Described the concepts of interoperability in healthcare (KL01)

Described how interoperability works between health IT/eHealth and related information systems, applications, programs, devices and tools (KA04)

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This project has received funding from the European

Union’s Horizon 2020 research and innovation programme

under Grant Agreement No. 727552

EUUSEHEALTHWORK

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Unit Review Exercise/Activity

1. Name the six healthcare areas where data is commonly exchanged with interoperable systems

2. What are the three levels of interoperability?

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This project has received funding from the European

Union’s Horizon 2020 research and innovation programme

under Grant Agreement No. 727552

EUUSEHEALTHWORK

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Unit Exam 1. Which of the following is a common area where health data

is exchanged with interoperable systems?a. a patient’s smartphoneb. a social media web portalc. a public health laboratoryd. a high school chemistry laboratory

2. With interoperable health records, which of the following is true?

a. The information must be entered using the same EHRb. Ideally, information is independent of time and place of delivery of

carec. Data is required to be based on HL7 standardsd. The patient usually brings a scanned copy of the paper records

with him or her

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Unit Exam (cont’d) 3. Which of the following is both a level and a type of

interoperability?a. Semanticb. Syntacticc. Foundationald. Structural

4. The step toward interoperability that may speed up and reduce complexity of interoperability is:

a. Standard implementationb. Common standard engineeringc. Common standard testing/pilotingd. Common open-technology platform

This work is produced by the EU*US eHealth Work Project. This project has received funding from the European Union’s Horizon 2020 research and

innovation programme under Grant Agreement No. 727552 EUUSEHEALTHWORK

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