Lecture 13
System Integration and
Interoperability
(Chapter 13)
http://www.csun.edu/~dn58412/IS531/IS531_SP16.html
Learning Outcomes
1. System integration and interoperability for
healthcare delivery.
2. Interface in system integration
3. Types of system interoperability
4. Benefits of integration and interoperability
5. Integration issues
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HIT Ecosystems
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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.
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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
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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”
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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
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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
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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
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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
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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).
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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
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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
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Interoperability Efforts
• OpenEHR to provide “archetypes” highquality, 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”
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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
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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
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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
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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
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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 MedicalClinical Terms (SNOMED-CT) recognized
by American Nurses Association (ANA)
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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
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References
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/ONC10yearInteroperabilityConce
ptPaper.pdf
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