This document summarizes a presentation on interoperability in healthcare. It discusses the current state of interoperability, definitions of interoperability from various organizations, components of interoperability including foundational, structural, semantic and organizational. It also discusses the Fast Healthcare Interoperability Resources (FHIR) standard and reasons for its adoption, as well as ongoing challenges to achieving interoperability in healthcare. In conclusion, the presenter thanks the audience and provides contact information.

1. 2019 MOHIMA ANNUAL MEETING
PRESENTS
Interoperability State
of the Union
Dave Lingerfelt, MBA, FHIMSS

2. ABOUT ME…
• 20+ Years in Healthcare
• Engineering/Info Systems Background
• Educator/Consultant
• President-Elect of Greater KC HIMSS
Chapter
• HIMSS Fellow

3. CONFLICT OF INTEREST
• I have no conflict of interest with this event or presentation
• Content is of my own professional opinion and does not reflect opinions or
positions of:
• MoHIMA/AHIMA
• HIMSS/GKC HIMSS
• Rockhurst University

4. THE WHY…
• EHR market to reach 33,294 mill by 2023
• Cloud based segment accounts for more than two-fifths.
• Ambulatory expected to be fasted growing at 5.56%
• New opportunities in inpatient sector continue to diminish
• Continued increasing demands on the system

6. Healthcare is out of step with other industries: we can access our
money from ATM machines anywhere in the world; we can send
text messages to any mobile network; and we can use
applications to service a myriad of needs (whether dietary,
fitness or entertainment) on our smart phones. But they’re still
keeping paper notes in some hospitals.
-Interoperability Showcase

7. BUT ITS COMPLEX
A clinical record can contain more than 100,000 different data
fields and elements including numeric data, structured text,
unstructured text and scanned files and images. Often EHRs
have also been tinkered with by internal IT departments to
evolve software products to a specific organization’s needs –
which means different data fields have been defined that aren’t
necessarily the same as what a comparable EHR has.

9. FURTHERMORE….
• State funded and special purpose HIE’s don’t talk well to each
other
• Many provide limited information
• Lack of sharing and standardization across vendors
• Too much info still stored in unstructured data format

10. INTEROPERABILITY….DEFINED
The ability of computer systems or
software to exchange and make use
of information

11. PER AHIMA…
Interoperability is the ability of different information
technology systems and software applications to
communicate, to exchange data accurately,
effectively, consistently, and to use the information
that has been exchanged.

12. PER HIMSS…
Interoperability is the ability of different information
systems, devices or applications to connect, in a
coordinated manner, within and across
organizational boundaries to access, exchange and
cooperatively use data amongst stakeholders, with
the goal of optimizing the health of individuals and
populations.

13. LET’S REDEFINE SHALL WE?

15. NEW PROPOSAL…
Interoperability is the ability of different information
systems, devices or applications to connect, in a
coordinated manner, within and across
organizational boundaries to access, exchange and
cooperatively use data amongst stakeholders, with
the goal of optimizing the health of individuals and
populations.

16. LET’S DECONSTRUCT
Interoperability is the ability of different information
systems, devices or applications to connect, in a
coordinated manner, within and across
organizational boundaries to access, exchange and
cooperatively use data amongst stakeholders, with
the goal of optimizing the health of individuals and
populations.

17. FURTHER DEFINES INTO 4 COMPONENTS
• Foundational
• Structural
• Semantic
• Organizational

18. FOUNDATIONAL
Foundational: interoperability develops the building blocks of
information exchange between disparate systems by
establishing the inter-connectivity requirements needed for one
system or application to share data with and receive data from
another. It does not outline the ability for the receiving
information technology system to interpret the data without
interventions from the end user or other technologies.

19. STRUCTURAL
Structural: interoperability defines the structure or format of data
exchange (i.e., the message format standards) where there is uniform
movement of healthcare data from one system to another such that
the clinical or operational purpose and meaning of the data is
preserved and unaltered. Structural interoperability defines the syntax
of the data exchange. It ensures that data exchanges between
information technology systems can be interpreted at the data field
level.

20. SEMANTIC
Semantic: interoperability is the ability of two or more systems to
exchange information and to interpret and use that information.
Semantic interoperability takes advantage of both the structuring of
the data exchange and the codification of the data, including
standard, publicly available vocabulary, so that the receiving
information management systems can interpret the data. Semantic
interoperability supports the electronic exchange of patient data and
information among authorized parties via potentially disparate health
information and technology systems and products to improve quality,
costs, safety, efficiency, experience and efficacy of healthcare delivery.

21. ORGANIZATIONAL
Organizational: interoperability encompasses the technical
components as well as clear policy, social and organizational
components. These components facilitate the secure, seamless
and timely communication and use of data within and between
organizations and individuals. Inclusion of these non-technical
considerations enables interoperability that is integrated into
end-user processes and workflows in a manner that supports
efficiencies, relationships and overall health and wellness
through cooperative use of shared data both across and within
organizational boundaries.

22. NOW ADD MORE COMPLEXITY…

23. AND MORE…

24. JUST A LITTLE BIT MORE…

25. WHAT ABOUT FHIR?

26. FHIR-DEFINED
Fast Healthcare Interoperability Resource (FHIR), a draft data
standard developed and nurtured by HL7 International. Was
designed to support the complexity of healthcare.
Philosophy: To build a base set of resources that, either by
themselves or when combined, satisfy the majority of common
use cases.

27. WHY FHIR?
• Other current options to make systems talk rely on document
exchange, not allowing the complete picture
• FHIR allows developers to move beyond the document
exchange layer
• Reduces the burden of data reconciliation

28. WHO’S USING IT
• In use in varying degrees by all major vendors (Cerner, Epic,
etc)
• Part of ONC Interoperability Roadmap
• ONC FHIR App challenges

29. PATIENTS AND PROVIDERS
• Help to bridge the missing link between personal devices
• Great for situation specific apps
• Reduce portal complexity

30. DRIVING FORCES
• Strong desire for pluggable apps and consumer facing
innovation (i.e. Apple Health App)
• API Requirements of 21st Century Cures Act
• ONCs Trusted Exchange Framework
• Payer-to-Provider relationships (i.e. DaVinci Project)
• FHIR at Scale Taskforce (FAST)

31. YET THE CURRENT STATE OF HEALTHCARE

33. TO CONCLUDE
• Still much progress to be made
• Landscape more dynamic than ever
• Continued competing interests

34. THANK YOU
Dave Lingerfelt; MBA, FHIMSS
Director/Professor Rockhurst University
Dave.Lingerfelt@Gmail.com
913-221-7956