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IS531_Lecture-13.ppt

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Lecture 13

System Integration and Interoperability

(Chapter 13)

Learning Outcomes

System integration and interoperability for healthcare delivery.

Interface in system integration

Types of system interoperability

Benefits of integration and interoperability

Integration issues

IS 531 : Lecture 13

HIT Ecosystems

IS 531 : Lecture 13

Why 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.

IS 531 : Lecture 13

Benefits of Integration

Allow instant access to application and data
Improve data integrity with single entry of data
Decrease data entry cost
Facilitate the formulation of accurate and complete patient record
Facilitate information tracking for accurate cost determinations

IS 531 : Lecture 13

System Integration

Different information systems should be able to exchange data in a fashion that is seamless to the end user
This exchange occurs across an “interface”

IS 531 : Lecture 13

Types of 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

IS 531 : Lecture 13

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

IS 531 : Lecture 13

Interface Engine …

Benefits of Interface Engine
Timeliness and availability
Decrease integration cost, time, effort as alternative to point-to-point type
Improve data quality with data mapping
Preserve institutional investment in existing systems
Simplify data processing
Improve management of care, financial tracking for care rendered, and efficacy of treatment

IS 531 : Lecture 13

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

IS 531 : Lecture 13

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).

IS 531 : Lecture 13

Interoperability

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

IS 531 : Lecture 13

Types of Interoperability

Syntactic (functional/process)—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
Process—business processes at related organizations/partners can wok together

IS 531 : Lecture 13

Interoperability Efforts

OpenEHR to provide “archetypes” high-quality, reusable clinical models of content and process
“Header”, “definition”, “ontology”
Service-oriented architecture (SOA) to create key functions as modules
Reusable, self-contained “object”
Vendor and technology neutral
Readily available in “registry of service”

IS 531 : Lecture 13

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

IS 531 : Lecture 13

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 among providers

IS 531 : Lecture 13

Drivers / Success Factors

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

IS 531 : Lecture 13

Integration Requirements

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

IS 531 : Lecture 13

Uniform Language

Provides uniform definition of terms
Facilitates communication and ability to exchange data with a shared meaning
Facilitates ability to replicate research
Systematized Nomenclature of Medical-Clinical Terms (SNOMED-CT) recognized by American Nurses Association (ANA)

IS 531 : Lecture 13

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

IS 531 : Lecture 13

References

IS 531 : Lecture 13

HIMSS (2016), Interoperability & Standards

http://www.himss.org/library/interoperability-standards

HIMSS (2016), Interoperability Showcases

http://www.himss.org/News/NewsDetail.aspx?ItemNumber=47751

HIT (2014), 10 Year Vision of HT Operability

http://www.healthit.gov/sites/default/files/ONC10yearInteroperabilityConceptPaper.pdf

IS 531 : Lecture 13