Beyond the buzzword: what's the actual reality of interoperability?

Why you should ignore the hype and focus on what you actually need to launch a project?

From our Chief Technology Officer, Duncan Harris

Interoperability is a term that seems to mean lots of different things to different people, yet it’s something many seem to have at the top of their healthcare wish list. It would be amazing for medical teams to not have to use 10 systems a day, but interoperability is so much more than this.?

For those of you who don’t know me, I’m the Chief Technology Officer here at Clinitouch . I’m going to be touching on what I think the actual reality of interoperability looks like in healthcare, the challenges that fall alongside it and how we should be working together to improve it for the future.?

What is interoperability??

As with the likes of AI, interoperability has become a bit of a buzzword in digital health, so I want to start with an important distinction. Many people often confuse it for integration, but in fact, it’s much bigger than that. In simple terms, integration is getting everything joined up and data flowing in the way you need it to – plugging things together.?

Interoperability is not only about transferring data between systems, but making sure it’s accessible and usable across platforms by the people who need it. It’s the capability for people to be able to access the data they need, to do their job effectively.??

You need to have integration to be able to achieve interoperability, but a lot of people stop at integration, because to do more than that is actually very hard to get right.??

Interoperability isn’t needed to get projects off the ground?

Of course, full interoperability in healthcare projects is the ideal solution – but it’s not the reality for most, and it’s certainly not always needed to get started. For those with interoperability at the top of their to-do list, what’s important is to understand why it’s at the top. Why is it needed to get your project off the ground??

Some of the initial questions you should be asking are: What are you trying to achieve? Who needs to see the data and why? Can you fulfil what’s needed on your end? After working with the UK’s NHS on several integration projects, we’ve found it’s crucial to do an upfront analysis of any project before conversations are started about how data should flow.??

Trying to build a full interoperability piece can be costly too. Answering the questions above are a great start to drill down what’s actually required to get moving – and in most cases that won’t involve interoperability.??

Viewing interoperability as purely an IT problem is the biggest trap??

In an ideal world, all systems would seamlessly integrate, and information would be available where you need it – but this isn’t the case. Especially in healthcare, we have this patchwork of systems and if you look at other industries like banking, aviation, or electronics, they are working to standards to achieve worldwide compatibility. This is where healthcare is falling behind.?

I think a common misconception is that integration and interoperability are achieved with the flick of a switch for your IT team. In reality, it requires a deep understanding of your organisations’ processes, the roles involved and what data is needed and where.?

Even if you do have an agreement across the company and understand what’s needed, interoperability is not a one size fits all approach. What works for one organisation may not work for another. When adopting a standard, it needs to be considered how this will affect all other forces acting upon that organisation. The engagement work needed on a project like this is often a big stumbling block.?

Creating our own standard won’t move us forward?

Adhering to common standards is pivotal for achieving interoperability across diverse systems. This not only helps to establish a shared language and structure for data exchange but allows us to integrate and communicate with each other. It can also be a great help in streamlining processes, proving more cost-effective. When developers can focus on creating solutions that align with established standards, we foster a marketplace of interoperable tools and services that we can all use and benefit from.?

For instance, we have adopted a global healthcare data standard called FHIR (Fast Healthcare Interoperability Resources). This follows a set of rules designed to facilitate the exchange of healthcare data among different IT systems – all with the aim of improving the efficient sharing of patient data. By holding these standards at the heart of our platform, we are hoping to facilitate better collaboration with other platforms and systems, while meeting credible, safe guidelines.?

Many electronic patient record (EPR) providers don’t use or actively promote their use of these universal standards. So, if we want to achieve interoperability for the benefit of everyone, those who have influence with EPR companies need to be having conversations with them, with the aim of ultimately swapping proprietary standards to be more compatible with other systems. If it wasn't for the commercial factors at play, we may have seen more interoperability advancements with these platforms by now - although, of course, we understand the need for private companies to protect their IP. It's a balancing act that we all need to figure out collectively.?

Data should be decentralised??

The prevailing opinion in healthcare seems to be that to get health data right, it must be accumulated in big central silos. The view is that by centralising data, you can create a joined-up view of a patient’s health data that anybody with the relevant permissions can see. The trouble with that is that it quickly becomes a source of commercial interest. It puts a huge onus on big upfront security mechanisms that need to be in place as you pull huge amounts of health data into one place. Plus, it’s expensive to maintain and keep up to date too.??

I think data should be decentralised and purely managed by consent; it should flow by default to the right people who have a direct role in that patients’ care. This doesn’t need to preclude research bodies being able to learn from it, but it puts the patient in control of their own data. In my view, the way healthcare is currently going is wrong and we shouldn’t shy away from talking about how we can do things differently. However, working towards global standards is a good step in the right direction of being able to easily share the data to the people that need it.?

Moving forward, together?

Achieving interoperability in healthcare is difficult – and no one has cracked it yet. We’re doing what we need to do to be an effective player, but we need others who feel the same way to join that journey.?With our ecosystem of partners and their customers, we are working in collaboration to try and fix some of these challenges.

If you’re interested in building a better, more connected healthcare world, we’d love to hear how you think we can achieve this.