Unit 5 Systems Integration and Interoperability

Learning Outcomes Recognize the importance of system integration and interoperability for healthcare delivery. Explain what an interface engine is and how it works. Identify several integration issues, including factors that impede the process.

Learning Outcomes Discuss the relevance to system integration efforts of the data dictionary, master patient index, uniform language efforts, and clinical data repository. Consider how standards for the exchange of clinical data affect integration efforts.

Learning Outcomes Review the benefits of successful information system integration for healthcare providers and healthcare professionals. Define the role of the nurse in system integration efforts.

Learning Outcomes Understand how Web-based tools can provide an alternative method for obtaining patient information from diverse information systems.

System Integration Health and financial data are collected at multiple points within the healthcare delivery system. Redundant efforts are expensive, frustrating, waste time, and result in different “versions” with none being complete or error free. 6

System Integration Process by which different information systems are able to exchange data in a fashion that is seamless to the end user This exchange occurs across an “interface” 7

Interface Software that tells different systems “how” to exchange data Point-to-point: Directly connects 2 systems Requires custom programming Expensive Interface engine: Allows data exchange between sending and receiving systems 8

Interface Engine Allows data exchange between sending and receiving systems Uses translation tables to move data from each system to the clinical data repository, a database where collective data from all information systems are stored and managed 9

Clinical Data Repository Provides data definition consistency through mapping May also be referred to as the clinical data warehouse (CDW) Mapping—terms defined in one system are associated with comparable terms in another system 10

Real-Time vs. Batch Processing Real-time processing occurs immediately or almost immediately; used when speed is important. Batch processing usually occurs once daily at the end of the day (traditionally when there are fewer demands on the processor). 11

Interoperability Ability of two entities to exchange and predictably use data or information while retaining the original meaning of data Used interchangeably with term “interface” but interface engine routes information from system to system without enabling understanding/use 12

Types of Interoperability Syntactic (functional)—ability to exchange the structure of the data, but not the meaning Semantic—guarantees meaning of the exchanged data on both ends of the transaction Critical for clinical data 13

Interoperability Efforts Health Level Seven (HL7) Clinical Document Architecture (CDA) European Committee for Standardization (CEN) EN 13606-1 (EHRcom) OpenEHR Service-oriented architecture (SOA) 14

Integration Issues Massive undertaking Vendors failure to deliver on promises Lack of agreement on standards Politics and power Lack of agreement on data dictionary, data mapping, and clinical data repository Fear of change Competition 15

NHIN National Healthcare Information Network (NHIN) proposed as a means to advance healthcare information technology and realize the benefits that HIT. 2004 directive by President Bush for interoperable electronic health records by 2014 16

Status of the NHIN No nationwide health information now exists. There is some limited data exchange within smaller geographic regions. There is no single exchange standard at present that provides complete interoperability. 17

Benefits of Interoperability Improved access to information Improved physician workflow, productivity, and patient care Improved safety Fully standardized healthcare information exchange Estimated savings = 5% annual U.S. healthcare expenditures 18

Drivers Consumer demands for improved care Demands from managed care The move toward the EHR Improved trending Easier data collection for accreditation purposes, research 19

Integration Requirements May require enhancements to Data dictionary—defines terminology to ensure consistent understanding and use Master patient index (MPI)—database that lists all identifiers assigned to a client in all the information systems within an enterprise Clinical data repository 20

Uniform Language Provides uniform definition of terms Facilitates communication and ability to exchange data with a shared meaning Facilitates ability to replicate research 21

Data Exchange Standards HL7 Health Level 7 Major standard for the exchange of clinical data DICOMM Digital Imaging and Communications In Medicine Production, display, storage, retrieval, and printing of medical images 22

Role of the Nurse Must be involved in: Identifying and defining data elements that an interface can supply Determining measures to ensure the quality of data exchanged among individual systems Formation and maintenance of the electronic health record 23

Web Tools Web applications have been used to present data from different systems in an easy-to-use format. 24

Emerging Solutions Refined data exchange standards National priorities set Work has started on building the framework 25

Future Directions Improved technical standards eliminate some of the obstacles. A large financial investment is required to achieve interoperability before the promised return on investment can begin to be realized. 26