1. Unit 5 Systems Integration and Interoperability

2. 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.

3. 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.

4. 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.

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

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

22. 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

23. 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

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

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

26. 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