Understanding the Challenge of Software Interoperability
The healthcare industry has become increasingly complex, driven by new diagnostic and therapeutic innovations, advanced procedures, and a diverse range of professional specialties, each with unique requirements, workflows, and methodologies. To maintain the long-term stability of the healthcare system, healthcare organizations have turned to various health information technologies to digitize paper-based records into electronic health information.
These health information systems have contributed to better care coordination, improved data organization, timeliness, accuracy, and completeness of information, enhanced analytical capabilities, reduced medical errors, and lower costs. However, the current health information systems are often proprietary, heterogeneous, and designed for local access, resulting in siloed ecosystems within healthcare organizations.
The lack of interoperability between health information systems reduces the quality of care provided to patients and wastes resources. Accordingly, there is an urgent need to develop integration mechanisms among the various health information systems to allow for ubiquitous access to patient health information.
Defining Interoperability
Interoperability refers to the ability of systems to connect and exchange information with each other, in either implementation or access, without limitation. The interoperability between health information systems is of utmost importance and essential for better health service management, public health, quality and safety of care for patients, and clinical research.
The lack of interoperability leads to redundant, disorganized, disjointed, and inaccessible medical information, which can affect the quality of care provided to patients and waste financial resources.
Levels of Interoperability
There are several basic levels of interoperability that have been defined in the literature:
- Technical Interoperability: Establishing harmonization at the plug-and-play, signal, and protocol levels.
- Syntactic Interoperability: The capacity of two or more systems to share data and services using a common interoperability protocol.
- Pragmatic Interoperability: When interoperating systems are aware of one another’s processes and procedures.
- Dynamic Interoperability: When two or more systems can understand and take advantage of state changes in the assumptions and limitations they are making over time.
- Conceptual Interoperability: When the assumptions and restrictions of a meaningful abstraction of reality are aligned.
- Structural Interoperability: Recording multimedia, hypermedia, object-oriented data, and other forms of information.
- Functional Interoperability: Delivering functional requirements in a consistent, established manner.
- Semantic Interoperability: The ability of two or more systems to automatically comprehend meaningful and correct information transferred in order to deliver useful results as defined by the systems’ end-users.
Semantic interoperability is crucial, as it ensures that the receiving system understands the meaning of the sent information, even if the receiving system’s algorithms are unknown to the sending system.
Leveraging Standards for Interoperability
Various standards are widely used to achieve interoperability in the healthcare industry:
Transport Standards:
– HL7 FHIR: A fast, flexible, and secure standard for exchanging healthcare information.
– DICOM: The standard for medical imaging and related information.
Content Standards:
– CDA: An XML-based standard for clinical document content, allowing the entire patient medical history to be displayed in one document.
Terminology Standards:
– SNOMED CT: A comprehensive, multilingual clinical healthcare terminology.
– LOINC: A database of universal codes and names for identifying laboratory and clinical observations.
– ICD-10: The 10th revision of the International Classification of Diseases.
Security Standards:
– HIPAA: The Health Insurance Portability and Accountability Act, which sets standards for protecting sensitive patient data.
– ASTM: The American Society for Testing and Materials standards.
Architectural Approaches to Interoperability
Modern architectural approaches that support interoperability include:
Service-Oriented Architecture (SOA):
SOA is a software development methodology that allows services to communicate across platforms and languages to construct applications. SOA benefits organizations with features like reusability, simple maintenance, interoperability, high availability, reliability, and scalability.
Web-Based Architecture:
Web-based architectures leverage common web standards and protocols to facilitate interoperability between diverse systems and applications.
Overcoming Barriers to Interoperability
Despite the importance of interoperability, there are several barriers that healthcare organizations face:
- Legacy Systems: Many ancient healthcare systems have limited interoperability capabilities, as they were built for specific activities or facilities.
- Proprietary Designs: Some healthcare systems are designed to prohibit compatibility with applications from other manufacturers to protect market share and encourage hospital or clinic chain purchases.
- Resistance to Change: Most healthcare professionals are resistant to switching from paper-based to electronic-based systems.
- Lack of Administrative and Legal Support: Limited administrative and legal support for information technology and related practice changes hinders interoperability.
- Funding Limitations: Limitations on funding for information technology and resources constrain interoperability efforts.
- Privacy and Security Concerns: Concerns about patient privacy and data security can create roadblocks for interoperability initiatives.
Enabling Personalized Medicine and Drug Discovery through Interoperability
Personalized medicine approaches can address the challenges of managing complex chronic diseases by making it easier to access the data in the required formats. Interoperable electronic health records (EHRs) with a crucial link integrating clinical data are a necessary step to achieve personalized medicine.
Interoperability also benefits computational drug discovery, as it enables the seamless integration of various software, programs, and tools required for a typical research project. If system or tool developers consider the real-world use case situation relative to the interoperability of input/output files, this problem can be resolved.
Interoperability in Smart Manufacturing
The rising requirement for interoperability at all levels of the manufacturing ecosystem is one of the challenges that have come about as a result of the growth in manufacturing technologies like cyber-physical systems, the industrial internet, artificial intelligence, and machine learning. Industry-specific interoperability and their corresponding logical semantics can help comprehend this topic better.
The Path Forward: Developing a Global Interoperability Framework
Interoperability has a significant positive impact on various industries, including healthcare, drug discovery, and manufacturing. However, there are several barriers and challenges that have led to a lack of interoperability between systems.
To address these challenges, stakeholders should work together to develop a comprehensive interoperability framework that includes the following key elements:
- Policy Interoperability: Supporting early research, discussions, and joint pilot projects to test potential best practices and regulations.
- Technical Interoperability: Leveraging APIs and international standards to create common protocols and specifications that allow different services and applications to connect and work across jurisdictions.
- Network Interoperability: Establishing common rules and regulations to support the reliability and access of broader networks.
- Regulatory Interoperability: Developing mutual recognition agreements between countries, recognizing other countries’ regulatory approvals or certifications as valid.
By focusing on these different layers of interoperability, stakeholders can work towards building an open, rules-based, and innovative global digital economy that supports the free flow of data and digital services.
Conclusion
Interoperability is essential for harmonizing conflicting software and achieving seamless compatibility in the digital age. By understanding the different levels of interoperability, leveraging industry standards, and adopting modern architectural approaches, organizations can overcome the barriers to interoperability and unlock the full potential of their digital ecosystems. As the world continues to become more interconnected, developing a comprehensive global interoperability framework will be crucial for driving innovation, economic growth, and improved outcomes across various industries.
