Embracing Digital Interoperability for Public Good

Article co-authored by:

Madhu Pulasseri , Andrew Cottle and Ashok Kumar

Abstract:

More and more organisations across industries are realizing the need for, and power of, an interoperable ecosystem. While the basic construct on interoperability has been in force for many years, it has never achieved the scale and maturity to solve complex industry specific problems across several industries. In this paper, we explore the foundational aspects needed as well as the core tenets that will then come into play in the journey to achieve truly interoperable ecosystems. We also explore the positive impact those ecosystems can have in the lives of people.

Digital Infrastructure and its relevance on Interoperability

The term Digital Infrastructure is nothing new. Digital Infrastructures have been around for as long as computing. However, the ability to explore seamless Interoperability by powerful Digital Infrastructures has gained significant momentum in the past decade. In this context, a Digital Infrastructure can be seen as the glue between the physical layer (including connectivity, devices, servers, data centres, security devices, etc.) and the user layer encompassing a plethora of applications in a digital ecosystem. When a Digital Infrastructure is implemented at scale for public good where citizens use this for daily interactions is commonly referred to as Digital Public Infrastructure (DPI). A well structured DPI can integrate unique IDs, eligibility and entitlement checks, payments, health records, and many more. The DPI in India is a good example of how this can be implemented at scale and a great example of the role that both Government and the Private sector can together play in developing truly nation-building services.

Harnessing the potential of a Digital Infrastructure is enabled by applications operating seamlessly using scalable interoperable standards. Enabling a future ready Digital Infrastructure is one of the most foundational elements for achieving seamless interoperability.

Journey to an interoperable ecosystem

Interoperability can be defined as the ability of a system, user or service to communicate and function with other systems or services, that may be different in terms of architecture, geography or user base.

While the benefits of interoperability are relatively obvious, what is less clear is the right path to interoperability at scale. If we follow the trajectory of what (then) were hailed as advanced concepts like Enterprise Application Integration (EAI) and Service Orientated Architecture (SOA) over the past two decades, we will see multiple examples of organisations who have trodden down this path; a few partially successful, but most ending up inadvertently creating another set of legacy technologies. In most instances, the ability to expose and consume data seamlessly remained elusive due to the scale and complexity involved, as well as the ever-increasing amounts of data that become available as we move toward a more digital environment. The arrival of APIs looked at this problem slightly differently, by attempting to develop a relationship model with the various interfaces and data points; but many organisations have rushed into API-led implementations, seeing this as the silver bullet to their interoperability challenges without fully understanding the critical success factors that support effective interoperability (in both internal and external ecosystems).

While there are many variations and opinions on the ‘secret sauce’ to successful interoperability, boiled down, most roads lead to the following four key tenets – Vision, Competency, Standards and finally, Participation.

1.???? Vision:

Having a robust Vision for Interoperability is the starting point. One of the key differences in this Vision when compared to other ‘organizational Visions’ is the primary realization that you are dependent on other stakeholders and the success of every stakeholder is intricately intertwined. Fundamentally, an interoperable ecosystem is greater than the sum of its parts. Let us dive deeper into making of the Vision.

• Enabling a robust digital infrastructure is a long-term commitment – imagine this as a road network that you need to build before ramping up connectivity between cities. There is investment and planning to be done; and not for today or for a year; but for many years down the line. Given the rate of change in technologies, planning for the future often involves use of open standards and frameworks to facilitate minor adjustments as technology evolves, rather than wholesale changes that lead to significant and costly investment cycles;
• Align your organization’s vision to that of like-minded organizations, agencies or governments that will participate in the end state. This often involves upfront collaboration with those organisations and/or sectors to ensure a united view, but we will touch more on participation later on;
• Build partnerships with organisations that offer products and services. Again, collaboration is the key here and will assist in a culture of evolution rather than replacement.

Interoperability is not “yet-another-initiative”. It is a continuous journey that needs constant focus. However, investment cycles for robust interoperable ecosystems do not necessarily follow the same patterns. These ecosystems become self-sufficient and cash-flow positive when executed properly.?

2.???? Competency:

Often there is a shift in mindset required to support a truly interoperable direction. Once employed, these shifts form the underlying competency of an organisation to tackle the challenge of interoperability head-on. There are several steps to be taken to achieve competency. The most prominent of them are listed below:

• Think beyond data residing in data centres – on premise or in the cloud. Data relevant to interoperability may be anywhere, we need to think about how data is exposed and brought together with other data – often that we don’t ‘own’.
• Think beyond a centralised digital core. A centralised core may be needed for your core finance or accounting practices; but for most others, processing capabilities and the supporting digital infrastructure is moving closer to the action – also known as ‘the edge’. This should be supported by the recent advances in low latency communications and 5G where a traditional network may not be effective.
• Think beyond a data-warehouse (or lake or pool or whatever future terms could be). Focusing on building these data stores may have negative impacts on achieving interoperability at speed and scale.
• Exposing and consuming data from wider sources, often not in our complete ‘control’ increases cyber security challenges. Adequate steps should be considered as well as where interoperability sits along your organisation’s Risk/Reward continuum.
• Accept that you are not alone in the eco-system – build partnerships. Very few entities have solved this problem. Digital infrastructure is changing to reflect the growing importance of partner ecosystems. In a government context, these ecosystems could support a single view of citizen across multiple domains such as education, social services, healthcare and Taxation.

3.???? Standards:

Having a set of standards for a business function (or industry) is key to enabling true interoperability.

Take the case of a patient visiting a GP in the Healthcare industry. The GP may refer the patient to a hospital or specialist for further diagnosis. They may in turn send patient samples to a pathology centre, which then sends the results back to the hospital, specialist or GP. After successful treatment, the patient gets discharged. However, symptoms may appear a few months later and it is likely that the patient may visit the same or a different GP, hospital, pathology centre or other entities like a radiology centre and the entire cycle could repeat.

Imagine the number of systems involved in each of these interactions – GP, hospital and lab (plus potentially more) in each instance. They may also need to interact with a centralised health record of the patient maintained by the state/federal Health agencies. In several jurisdictions, there is no standard for exchanging data for these circumstances and in others, only intraoperability exists whereby data can be only be readily communicated within instance(s) of the same product, like an Electronic Health Record (EHR). Lack of standards cripples the ability to seamlessly exchange data and the ability to provide important health care to patients that may sometimes be time-sensitive and can have life altering implications. The Healthcare industry has attempted to do this with several versions of CDA, HL7 and the now prevalent FHIR standards. However, adoption of these is currently limited in many jurisdictions by multiple factors in the ecosystem.

Adopting a standard is never easy and has to be carefully thought through. Adopting standards also needs a larger ecosystem. In the example of healthcare listed above, a government(s) cannot do this in isolation. It takes a large-scale community made up of relevant stakeholders (from both Government and Private Sector, including clinicians) to do this.

Cycles where standards were developed and enforced have almost always ended up as shelf-ware. Mandates have rarely been successful in this domain. Going back to the example of building road networks; building more roads do not necessarily help reduce congestion if the entry/exit points are not easy or if there are several toll collection centres. Organisations need participants to adopt standards and develop more and more applications that seamlessly adopt the standards while utilising the power of underlying digital infrastructure.

Just like the overall vision, Standards should be developed with a 10 year+ or more view. One of the pitfalls of standards is that they often tend to fall into the hands of a select set of organisations who then control not just the standard, but also the developers, applications, and interactions. In many cases, these are driven by commercial motives. It is therefore important to adopt open standards and enforce open concepts all along the journey. This leads to the final tenet of interoperability, Participation.

4.???? Participation:

Digital infrastructure is increasingly becoming developer-led and software-defined. This encourages innovation and rapid mushrooming of start-ups who then contribute back into the standards and digital infrastructures while enabling access of data from interconnected systems.

A good example of this ecosystem operating at scale is in India where adoption of open standards has facilitated unbelievable innovation. While the government provides the basic ‘building blocks’ of digital infrastructure, there are thousands of applications and start-ups who leverage the infrastructure and standards to develop applications that provide financial transactions, commerce transactions, government services, travel services and many more; all at the same time contributing to the ecosystem in one way or another. In its Digital Agenda, the EU has identified the lack of interoperability as one of the most significant obstacles to digitalization. The EU has issued a proposal on an interoperable Europe act, which aims to assist the EU and its Member States in delivering better public services to citizens and businesses. In Australia, concepts such as the Government services front-door, MyGov, are heading in the right direction however may again be constrained by the lack of true interoperability across multiple domains that has been discussed earlier.

One of the successful attributes for effective participation is the ability to request, consume and provide data that is just needed (and not more) in a secure manner adhering to consent and privacy norms. It is important to move away from centralised to de-centralised networks to better support this.

Curated Role of APIs

APIs play a crucial role in addressing the complex challenge of interoperability, serving as the primary means of facilitating communication and data exchange between different systems. While APIs are often heralded as a key solution to interoperability issues, it is important to recognize that they are just one piece of the puzzle. In many industries, there are numerous systems that may not be API-enabled or may rely on custom APIs that lack standardization (the opposite intent of API’s).

In the healthcare sector, for example, legacy applications are common, further complicating the task of achieving interoperability. Simply relying on APIs as a cure-all for interoperability problems is not sufficient, as there are often a plethora of other factors that must be considered to successfully integrate disparate systems and ensure seamless data exchange.

It is essential for organizations to approach interoperability holistically, considering not only the role of APIs but also the broader landscape of applications and data sources that need to be integrated. While APIs may serve as the torchbearer for interoperability journeys, it is crucial to untangle the web of interconnected systems and data to achieve true interoperability.

Interoperability in the Healthcare sector

As has been alluded to numerous times throughout, the Healthcare sector is ripe for interoperability. Most jurisdictions around the world are facing some form of Health practitioner shortages, whether that be nurses, doctors, specialists etc. These shortages often lead to significant wait times to see clinicians resulting in more and more patients seeing multiple clinicians on their health journey, purely due to not being able to wait. This is where the concept of interoperability and having patient data ‘follow the patient’ regardless of who they are seeing, becomes a potential life changer.

Globally, there has been a push towards promoting interoperability in healthcare systems to ensure better coordination of care and data exchange among different healthcare settings. In the United States, there are consistent efforts to promote the use of standards like Fast Healthcare Interoperability Resources (FHIR) to enable the seamless exchange of health information between different EHR systems.

In Australia, the healthcare sector is also making strides towards achieving national health interoperability. Multiple government agencies have been working on initiatives to promote the adoption of FHIR as the standard for sharing health information across different healthcare systems in the country. The journey towards achieving national health interoperability in Australia will involve a long-term, coordinated effort from healthcare providers, government agencies, and technology vendors to adopt and implement FHIR standards.

In the Health sector, there is a direct link between successful interoperability and citizen and population health outcomes, further reinforcing the importance of a coordinated and structured approach to implementation.

Conclusion

The world is becoming increasingly interdependent. So are organisations and applications hosted by these organisations. Consumers will continue to demand more from providers, and they will expect information to be available to them as well as those that they think should receive this information at speed and with security. In the same vein, citizens are increasingly expecting more from Government services in line with the services they receive from commercial providers. Interoperability is not a choice anymore; organisations and governments need to act now to secure the future. Well-designed Interoperable networks can transform the lives of millions.