In healthcare, interoperability is an essential part of modern-day clinical workflows. Interoperability isn't something that started with modern healthcare and digitization. In history, different forms of standardization and interoperability existed.
Historically, medical knowledge was passed down from master to apprentice in many ancient healthcare systems, including traditional Chinese medicine and Ayurveda. This allowed for the sharing of knowledge and best practices between practitioners, but it was not a standardized system.
Some ancient healthcare systems used standardization to some extent. For example, the Indian Ayurvedic system classified all diseases into eight categories, which helped standardize diagnosis and treatment.
In ancient healthcare systems, however, it was difficult to share patient information across practitioners and geographic locations due to a lack of standardized medical practices and documentation.
Many traditional healthcare systems did not grow beyond certain boundaries and many novel concepts were lost or not retrievable, although not entirely due to interoperability or standardization.
History is unequivocally a thing of the past, and in our digital age, healthcare data processing has grown exponentially. Health organizations now have numerous medical instruments and information technology systems to facilitate their operations, including EMR/EHR, PACS/RIS, workstations, reporting systems, modalities, patient monitors, etc. It is imperative that these various pieces are connected in a way that makes sense.
Many healthcare providers around the globe define their workflows according to their operations as a result of standardization and interoperability.
The same standard workflow defined by IHE (Integrating the Healthcare Enterprise) SWF (Scheduled Workflow), PIR (Patient Information Reconciliation), or CCW (Cardiac Cath Workflow) is not suitable for healthcare providers.
In other words, healthcare providers customize standards according to their IT infrastructure, systems, and the type of service they provide to patients, citizens, healthcare, etc. Sometimes deviates too.
There can be catastrophic consequences if there is a misunderstanding between these IT systems functioning together, they are as follows:-
Services are disrupted.
Breach of privacy
Fatalities to patients
Patient outcomes may be incorrect
According to data from the National Coordinator for Health Information Technology, interoperability and standardization in healthcare cost the US healthcare system more than $30 billion. This number should be in the hundreds of billions worldwide. In addition to that, it is affecting the accuracy and efficiency of the system.
There have been many large healthcare organizations that have understood the importance of interoperability over the years and have been investing a lot of money and resources into exploring and maintaining it. Many Digital Health solution providers have entered the market in the past few years, and they are still trying to figure out the significance of these standards.
There have been many standards and protocols introduced to healthcare over the last few decades to solve these problems, such as #hl7 , #fhir , #dicom , DICOM-web, SNOMEDCT, LIONIC, ICD-10, CCDs, XDS, etc.
In addition, healthcare providers can standardize their workflows to bring standardization of data and interoperability within and outside the scope of their organizations. One such internationally accepted standard to make the life of patients across geographies seamless is IPS(International Patient Summary). A must-have standard to follow.
Despite using IT systems from well-known healthcare vendors and following workflows defined by #ihe, many healthcare providers still aren't able to interact with other healthcare providers.
We must ask ourselves whether the life of a patient is more important than commercial or regulatory reasons.
Around the world, initiatives to protect patients' interests are growing in popularity. Germany is leading this trend, introducing the Hospital Future Act (Das Krankenhauszukunftsgesetz / #khzg ) and granting 3 billion euros plus an additional 1.3 billion euros for its implementation. This represents a major step forward for patient empowerment and creating standardized Digital Healthcare systems. Similarly, the USA, Canada, and Australia - to name but a few countries - are taking similar measures, learning from the SARS-CoV2 pandemic along the way. Many Digital Health solution providers have endorsed and embraced these changes.
Interoperability among systems across healthcare providers will ensure the effectiveness of any initiative.
Technology-wise, especially in the Cloud, there are many ready-made solutions for interoperability that are coming from Google, Microsoft, and Amazon.
Managed services are available to some extent to handle interoperability.
Google Cloud Healthcare API
Azure API for FHIR, DICOM service, etc.
AWS HealthLake(Not full-fledged like Google)
If an organization prioritizes interoperability as a crucial factor, it can enhance its business performance and also benefit its customers. For digital healthcare solutions to be successful, it's crucial to comprehend healthcare providers' workflows, their IT systems, and how they conform and integrate with relevant standards and protocols.
In developing healthcare solutions with interoperability in mind, here are three takeaways:-
The first step is to understand the business and define your design for interoperability as closely as possible to the standard.
Ask your IT team if they are violating the standards, and if so, what they are doing to correct them.
Participate in IHE connections or other integration events as a solution provider to explore the hospital ecosystem.
Here are three things any healthcare provider should keep in mind when purchasing systems from healthcare vendors:
Request integration and conformance statements of interoperability from your solution provider.
Ask for evidence instead of trusting the marketing or sales of the solution provider
If your IT team is violating standards, record and audit them regularly.
If you are the decision maker of a healthcare solution provider, keep these things in mind because otherwise your solutions will be less usable and will be loosely integrated.
While for a healthcare provider, this would make the hospital workflows more cumbersome and error-prone, leading to a poor reputation as a healthcare provider. Over time, you be forced to go for a better and more integrated solution.
#interoperability in healthcare has been, is, and will continue to be a necessity in the past, present, and future. The tips I have given are very important for a decision-maker. However, a long list of checkpoints is needed to verify that you are prepared and ready for interoperability.
Future healthcare interoperability will be handled by artificial intelligence by validating and correcting errors. Already this is pretty visible. This is definitely a discussion point on utilizing LLMs(Large language models) for interoperability.
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