information technology

Integration, Interoperability, and

the Future of Healthcare

Unlocking clinical data will drive improved patient outcomes.

If there’s ever been a time for ensuring providers have access to the most accurate,

connected data, it’s now. Yes, we have successfully moved from paper filing systems to

electronic health records (EHRs) over the past decade. And that’s great. But the COVID-19

pandemic has shown that’s not enough. Now, more than ever, we need a complete view of

the patient to safely deliver care and promote the health of the population. How do we get

there? The industry seems to have come to a consensus on the answer: through

interoperable systems.

It wasn’t long ago we were shifting from paper to digital. Our ambitions grew as healthcare

reached for a complete view of the patient, no matter where the data resided. Despite many

incentives, data sharing advanced slowly. So, the U.S. Congress got on it, with the 21st

Century Cures Act and its open APIs “Without Special Effort.” The White House and CMS

got on it, with incentive programs and the MyHealthEData Initiative. And standards

organizations and collaborations got all over it. Salesforce is a vital part of this effort,

working diligently to move closer to a 360-degree view of the patient and to foster

a healthcare system that can attend to patient needs in real time — especially during a

crisis like the coronavirus pandemic. Interoperability is the brass ring in achieving these

goals.

Competitive and cost pressures are pushing us harder than ever toward an interoperability

model. We see this come to life in the spate of recent mega-deals, including: CVS buying

Aetna in 2018, GM Motors contracting with Henry Ford Health Systems to launch direct-to-

employer healthcare, and companies like Amazon, Berkshire, and JP Morgan teaming up to

tackle employee health. When those kinds of companies come together, so do their

systems, creating an opportunity to gain insight from rapid aggregation. This all can lead

more quickly to new strategies, products, and services. It also can lead to an invaluable

source of truth for patient data — all of which will improve trust between providers and

patients, and, ultimately, healthcare outcomes.

The initial phase of going digital helped create the EHR system. Now we aim to go beyond

EHR and toward API-enabled, interoperable systems. Technology has advanced so much

in the past decade; our toolkit is so much more robust, with blockchain, advanced analytics,

and, of course, CRM. They are not, however, all neatly packaged in the EHR.

At Salesforce, we see so many factors speeding us toward interoperability: the rise of value-

based care and regulatory disruption, the accelerated creation of industry data and

services, as well as the need to access modern digital capabilities. It’s all exciting but it will

take time before interoperability becomes routine and patients can reasonably expect a

consumer experience that is as convenient as ordering dinner online or getting served

entertainment that understands their tastes. It also doesn’t feel all that far away. In this

guide, we explore the need for interoperability in our healthcare system, the roadblocks

preventing it from thriving, the interim steps we need to take, and the role of integration.

Then we introduce you to industry pioneers who are paving the way for truly connected

healthcare.

• Chapter 1: What Is Interoperability?

• Chapter 2: Salesforce’s Approach to Integrated Solutions

• Chapter 3: Leveraging APIs to Drive Interoperable Systems

Chapter 1: What Is Interoperability?

The U.S. healthcare system is a vast web of systems, applications, and data. The majority

of hospitals and private practices have implemented an EHR of some kind, which is helpful,

but most of these systems are completely separate from each other, muddying the view of

each patient’s health, and hampering care coordination and improved population health.

These shortcomings result from three challenges:

1. Siloed patient data across clinical and nonclinical systems. This creates fragmented

experiences and missed opportunities for preventative and total health. Yet, many IT

decision makers are still at a loss on how to connect the data. Accenture reports that in the

fall of 2019, one in six (17%) healthcare executives were “completely unaware” of new

legislation coming out in March 2020 that would require greater patient access to and

sharing of healthcare records.

2. Legacy health IT proving incompatible with modern engagement technology. This delays

efforts for digital transformation. In fact, 64% of IT leaders cite legacy infrastructure,

processes, and tools as a top barrier to transformation.

3. System connections that are driven by point needs for data. This results in a growing

inventory of point-to-point integrations that are costly to maintain and don’t scale well

enterprise wide. And with 75% of U.S. hospitals managing more than 10 EHRs, maintaining

these connections becomes exponentially cumbersome.

To truly achieve a complete view of the patient, healthcare organizations must be able to

seamlessly connect with and act on data collected by the patients’ overall care team across

multiple providers. And they must be able to preserve all the context that comes with the

data. This is where interoperability shines.

Interoperability takes systems integration to the next level. As it matures, interoperability can

use integrated connections to drive meaning across systems by giving context to the data. It

does this by enabling information systems, devices, and applications to access, exchange,

integrate, and cooperatively use data in a coordinated way within and across organizational,

regional, and national boundaries.

Integration connects disparate systems but may not carry the context of the information it

brings together. It performs a vital function, orchestrating multiple interfaces that support

process automation. It also brings together component subsystems into one system,

ensuring that they function together as a unit. Integration is the foundation for

interoperability.

While many systems integrate, the data they share frequently lacks context. By contrast

interoperable systems can talk to each other in the same language — preserving meaning,

without the added complexity or delay. Interoperability allows computer systems to transmit

data with increasing sophistication across four key levels. As outlined by the Healthcare

Information and Management Systems Society (HIMSS), these four levels are:

1. Foundational. Establishes the interconnectivity requirements needed to securely

communicate data to and from another.

2. Structural. Defines the format, syntax, and organization of data exchange, including at the

data field level for interpretation.

3. Semantic. Allows for common underlying models and codification of the data, providing

shared understanding and meaning to the user.

4. Organizational (new). Includes governance, policy, social, legal, and organizational

considerations to facilitate the secure, seamless, and timely communication and use of

data, both within and between organizations.

Interoperability is the ultimate goal. But healthcare won’t reach it until the entire healthcare

IT ecosystem can seamlessly connect and transmit all clinical and nonclinical information

necessary to drive the most well-informed, best possible outcome for each patient. Until

then integration will continue to evolve to a higher level as it aims for meaningful

interoperability.