Where does real interoperability start?

What is ‘interoperability’ and why is it important?

Interoperability is about data and information having a consistent meaning enabling it to move and be used meaningfully between people, organisations and systems. Digitisation of healthcare that focuses on the patient and enables ready access to the relevant care information for those who have a legitimate need means that data and information must be interoperable — for the patient, this is a critical element.

How do data standards play a role in this vision of interoperability?

It is easy to focus on the infrastructure pieces, the large systems and solutions, or even the small edge technology that does amazing things or ‘goes ping’ because you can see and touch them. But underpinning their workings sits data. Whilst brilliant minds across technology have often developed data formats, schemas and proprietary solutions to problems and have implemented them within technology platforms. Whilst these home-grown solutions might work perfectly well in isolation, once data needs to be shared across technology platforms, between organisations, into centralised records or even across borders the necessity to be able to interpret it in a commonly defined way throughout the process means that these innovative ideas often fail to scale. Enter then data standards.

The data standards we need are already available

Not only are the data standards already available for many of the foundations, but in many cases, the implementations have already begun — at least elsewhere around the world. The issue is not whether the standards exist, it is ensuring that we are implementing them within Australian healthcare and the solutions we are deploying as we ‘digitalise’ our healthcare ecosystem. It is sometimes hard to understand why the progress has not been faster. To be fair it is not always the fault of the solutions, the issue is often that we are not clear on what standards should or in some cases must be implemented for the various areas within the health system, and with an absence of clarity we stick to the status quo and wait. While we wait, the digitising using non-scalable proprietary solutions continues, meaning that we will need to likely find funding across the various organisations to make changes to systems and processes — adding costs that Australian healthcare can ill afford and needing resources that are often in limited supply.

What does the standards landscape look like for healthcare?

There are a large set of standards that apply within healthcare and thankfully many have been developed in parallel to ensure that they are interoperable or complement each other. Here are just some that are being implemented across healthcare.

• Healthcare Identifiers used to manage the identity of individuals and healthcare providers within My Health Record and related systems are all based on the ISO7811-3 and ISO7812 and defined for Australia specifically within AS 4846.
• Several ISO standards provide guidance in areas related to Health Informatics. One such standard is ISO18530, which provides guidance related to the standards to enable the identification and data capture of subjects of care and providers within healthcare providers and care delivery. This standard enables the transition from internal MRN/URN to a unique and unambiguous identity for patients and has already been implemented in some health organisations in Australia.
• Snomed CT is a comprehensive global clinical terminology standard that enables clinical content to be easily represented within clinical systems enabling automated processing of clinical data. It provides the basis for Australian Medicines Terminology (AMT).
• Fast Healthcare Interoperability Resources (FHIR) is an HL7 standard that originated in Australia, describing data formats and elements and an application programming interface for exchanging electronic health records across a variety of clinical workflows.
• With increased focus on the ‘traceability’ of products and a greater understanding of the need for digitisation to enable critical supply chain improvements, the utilisation of GS1 global data standards has also increased in line with the vision for the healthcare supply chain that was defined under the National eHealth Transition Authority (NeHTA), the predecessor to the Australian Digital Health Agency (ADHA). Use of GTIN for products, GLN for places & parties and SSCC for shipments along with standardised Electronic Data Interchange (EDI) to digitise ‘procure to pay’ are expanding within Australian healthcare organisations, especially where new regulations are driving the need for change, or it aligns to broader infrastructure initiatives such as the National Freight and Supply Chain Strategy.

What comes next?

A patient-centric healthcare system supported by data and information cannot be achieved without interoperability, and for this, universal open standards need to be in place. With updated interoperability frameworks and standards frameworks being delivered by the ADHA, this will go some way to creating the much-needed clarity concerning what standards should be being implemented to support local needs. This clarity will enable scaled engagement, with the solution provider community supporting Australian healthcare to drive necessary development and inclusion within solutions used in the sector. By removing the need for specific projects to implement standards, the added cost, drain on resources and delay in the many projects around the country should be possible — in short, the benefits to the Australian health system will be significant.

Learn more about standards in healthcare: https://bit.ly/3xYb1ZP

Image credit: ©stock.adobe.com/au/Hilch