Today, public health and healthcare organization CIOs and their IT leadership teams are facing several challenges including:
- No single source of truth for data integration and curation.
- Multiple copies of data in different formats.
- Large movement of unstandardized data and system capacity to handle it.
- Increased pressure for faster and more efficient data integration and sharing.
Our Advice
Critical Insight
- To address these challenges head on, focus needs to be on standards-based Interoperability to provide timely, safe, and secure access, integration, and exchange of electronic health data so that it can be used to optimize health outcomes for individuals and populations automatically and in real time.
- Effective approaches to interoperability will result in better outcomes for population health and improved efficiencies – including cost reductions and maturity of infrastructure, platform, and data exchange services – across health and healthcare organizations.
Impact and Result
Enterprise-wide operational improvements will be realized by:
- Building awareness and knowledge of interoperability definitions, types, and standards.
- Gauging the impact of interoperability through capabilities mapping by assessing the defining, supporting, and enabling capabilities for interoperability readiness.
- Learning about interoperability and how it affects both your organization as a whole and IT specifically, including challenges and opportunities.
Interoperability Primer and Playbook for Public Health and Healthcare Organizations
For standards-based interoperability readiness and safe, secure electronic health information exchange.
EXECUTIVE BRIEF
Analyst Perspective
Health and healthcare organizations prioritizing interoperability will improve data exchange capacity and capability. This will ensure rapid, safe, and secure gathering, sharing, analyzing, and reporting of electronic health information, resulting in reduced costs and improved health at both the individual and population level.
What is interoperability and why is it important?
Overview
Interoperability refers to the ability of two or more computer systems to exchange, communicate, and make use of information to optimize health outcomes for individuals and populations.
To achieve interoperability, we must adopt and optimize electronic health record (EHR) technology and health information exchange (HIE) services. For health and healthcare organizations, standards-based interoperability enables authorized users from multiple locations to access, gather, integrate, and share electronic health information quickly and securely. Outcomes include better care coordination among healthcare organizations and improved nowcasting, forecasting, and scenario modeling among health and human services organizations.
We have reached the tipping point. Nearly 90% of providers use EMR/EHR technology and 72% use certified EMR/EHR technology. Nearly 70% are recording social determinants of health information. Across all hospital types, more than 95% have certified EHR technology and 70% are integrating data into their EHRs from sources outside their health systems. Like EHRs, HIE services must also be optimized, adopted, standardized, and used by healthcare providers, their patients, and public health practitioners in order to advance interoperability.
It will take time for all types of health IT to be fully interoperable. When interoperability is achieved across health and healthcare systems, and the widespread exchange of information becomes standard practice, providers and health and human services organizations will have the infrastructure to deliver patient-centric and population-centered, value-driven accountable care that improves health outcomes while reducing costs.
The Vision
Working diligently to move closer to a streaming 360-degree view of the patient and population and to foster a health and healthcare system that can attend to patient and population needs in real-time – especially during a crisis like the COVID-19 pandemic. Interoperability is the critical diagnostic and assessment/policy development/assurance/facilitating tool required to achieve these goals.
Neal Rosenblatt
Principal Research Director
Info-Tech Research Group
Executive Summary
Your Challenge
Public health and healthcare response and preparedness will be driven by real-time data that allow health and healthcare organizations to quickly identify when and where infectious disease outbreaks and chronic diseases occur and maintain insights about health system capacity (ONC 2021).
The challenge CIOs and their IT leadership teams are facing today include:
- No single source of truth for data integration and curation.
- Multiple copies of data in different formats.
- Large movement of unstandardized data and system capacity to handle it.
- Increased pressure for faster and more efficient data integration and sharing.
Focus on standards-based interoperability to provide timely, safe, and secure access, integration, and exchange of electronic health data so that it can be used to optimize health outcomes for individuals and populations automatically and in real time.
Common Obstacles
Business landscapes and models are rapidly evolving, and users and stakeholders are becoming more data-centric, with maturing expectations and demands for data access and automated, real-time analytics, reporting, and sharing.
Primary barriers or obstacles that prevent organizations from improving or addressing those challenges include:
- Weak alignment with core functions and essential services business capabilities.
- Lack of awareness or knowledge of the importance of interoperability – definitions, types, standards, and standards implementation.
- Infrastructure immaturity and lack of preparedness for participation in interoperable health information exchange networks at the state, provincial, and national levels.
Common Obstacles
Effective approaches to interoperability will result in better outcomes for population health and improved efficiencies – including cost reductions and maturity of infrastructure, platform, and data exchange services – across health and healthcare organizations.
Enterprise-wide operational improvements will be realized by:
- Building awareness and knowledge of interoperability definitions, types, and standards.
- Gauging the impact of interoperability through capabilities mapping by assessing the defining, supporting, and enabling capabilities for interoperability readiness.
- Learning about interoperability and how it affects both your organization as a whole and IT specifically, including challenges and opportunities.
Info-Tech Insight
This research is designed to help public health and healthcare organizations overcome several challenges by focusing on standards-based interoperability to optimize health outcomes for the individuals and populations they serve.
Your challenge
Interoperability challenges experienced today by health and healthcare organizations including providers, researchers, and public health professionals, continue to present difficulties with the usability of health information systems due to their shortcomings in supporting core function capabilities, the provision of essential services, and addressing stakeholder needs.
Examples of Business Capability Challenges Faced by Health and Healthcare Organizations Using HealthIT Today: |
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Issues |
Examples |
Data design and capture |
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Information integrity and quality |
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Inability to use data for analytics and advanced reporting |
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Lack of interoperability |
|
Source: AHIMA 2017
This research is designed to help health and healthcare organizations overcome these challenges by focusing on standards-based interoperability to optimize health outcomes for the individuals and populations they serve at foundational, structural, semantic, and organizational levels.
Share of Challenges Reported to be a Barrier to Health Data Sharing | |
---|---|
50% |
Quality of data that is shared |
54% |
Lack of technical interoperability |
43% |
Lack of data standardization |
29% |
Lack of trust between entities |
52% |
Timeliness of data that is shared |
Source: ONC and CMS, 2020: Survey Results: Readiness for the ONC and CMS Interoperability Rules
Common obstacles
If creating an interoperable health IT ecosystem is the key to unlocking the future of health and healthcare, and with so many benefits, why is it so difficult to accomplish?
- Competing interests
- E.g. financial, staff, and other resources
- Complexity
- Cost
- Lack of coordination between health systems, organizations, and agencies
- Inconsistent and lack of technical standards
- Numerous software systems with varying data standards
- Divergent health information privacy policies
- Differing approaches to gaining patient/individual consent
- Difficulty getting major EHRs to coordinate with each other
- Data gaps across different EHR applications and networks
- Data silos across the ecosystem that would inform the most urgent and impactful patient and/or population interventions
- The regulatory landscape continues to become increasingly complex:
- Rule revisions for government-sponsored programs occurring on a yearly basis
- Adds to providers' doubts as to whether technologies like machine learning can adapt to these constant regulatory changes
Overcoming BarriersShare of health and healthcare leaders worldwide who felt the following factors would support them fully utilizing health data: |
|
---|---|
27% |
More clarity as to how data is being used within my hospital/healthcare facility/health agency. |
23% |
Tracking performance metrics/KPIs to measure impact. |
22% |
Training/educating staff on usage. |
22% |
Addressing interoperability/data standards. |
24% |
Availability of data specialists to manage and analyze data. |
22% |
Investing in technology infrastructure within my facility/organization. |
22% |
Investing in cloud-computing tools and services. |
22% |
Integrating health/IT informatics as a core operating function. |
Source: Philips, 2022: The Future Health Index 2022 report
Info-Tech's approach
Unlock the value of interoperability.
The Info-Tech difference:
- Building awareness and knowledge of interoperability definitions, types, and standards.
- Gauging the impact of interoperability through mapping and assessing defining, supporting, and enabling capabilities for interoperability readiness.
- Learning about interoperability and how it affects both your organization as a whole and IT specifically, including challenges and opportunities.
- Capability Mapping
- Use the Capability Mapping tool as an interoperability readiness assessment process.
- Interoperability Assessment
- Identify interoperability types (foundational, structural, semantic, and organizational) across your organization.
- Interoperability Implementation
- Build types and standards into your organization's interoperability ecosystem one use case at a time.
- Interoperability Ecosystem
Executive brief case study
The future enablement of health interoperability outcomes 2030.
In May 2021, the Office of the National Coordinator for HealthIT (ONC) launched a project called "Health Interoperability Outcomes 2030." The project asked health and healthcare practitioners (n ≈ 700), "What should 2030 look like because of interoperability?" Outcome statements were collected and analyzed for trends, groupings, and combinations. The result was a prioritized set of interoperability outcomes focused on the end state of individuals having internet-based access to their electronic health information, setting the course for aspirational and achievable goals by 2030.
INDUSTRY: Government/
HealthIT
SOURCE: The Office of the National Coordinator for HealthIT
An aspirational vision of interoperable health systems by 2030
- The health system will enable evidence-based, precision care that accounts for the social and health conditions of each patient, including links between health and human services.
- The health system will more quickly identify high-risk conditions, chronic diseases, and disparities in health equity.
- The data used for clinical and administrative processes will be electronically integrated to support decisions about payment, eligibility, and benefits.
- Public health response and preparedness will be driven by real-time data that allow public health agencies to quickly identify when and where infectious disease outbreaks occur and maintain insights about health system capacity.
- Reporting for public health, quality measurement, and safety will all be completed automatically and electronically.
- Researchers will be able to use inclusive, representative datasets to compare the real-world performance of treatments, procedures, devices, and drugs.
- Research and testing for new decision support, workflows, and other work processes will be able to be conducted across multiple sites and among different technologies.
- Researchers and health professionals will spend little to no time normalizing data for research and quality activities.
- Preventable data-related safety events will be reduced to zero.
- Health professionals will spend less time on administrative tasks and more time caring for their patients.
- Duplicate diagnostic tests and procedures will be reduced.
Source: ONC 2021 | Synthesized statements that reflect respondents' overall sentiment about what health systems should look like in 2030 because of interoperability.
Insight summary
Overarching insight
This research is designed to help health and healthcare organizations overcome several challenges by focusing on standards-based interoperability to optimize health outcomes for the individuals and populations they serve.
1 Insight – Definitions and Levels
1.0 Standards-based Interoperability in health and healthcare organizations provides timely, safe, and secure access, integration, and use of electronic health data so that it can be used to optimize health outcomes for individuals and populations.
1.1 Health and Healthcare organizations prioritizing interoperability and standards will see improvements in data access, integration, management, retrieval of data and documents, scientific staff productivity, IT efficiencies, cost optimization, and data exchange capabilities. This ensures quick, safe and secure gathering, analyzing, and sharing of electronic health information in ways that follow all industry and HIPAA protocols.
1.2 Standards-based interoperable HIT solutions are becoming fundamental building blocks driving digital transformation, enabling financial efficiencies, and supporting standards development as well as the implementation, operation, and use of standards-based HIT solutions – specifically for services integration, cloud computing, cybersecurity, and information safety.
2 Insight – Standards Development
2.0 Standards provide a common vocabulary, code sets, structure, and guidelines that enable interoperability between systems and/or devices.
2.1 In order to seamlessly ingest and curate information without effort, standards permit clinicians, labs, hospitals, pharmacies, payors, patients, health information exchanges, healthcare services, and public health organizations to share data regardless of application or market supplier.
2.2 Interoperability standards development works to increase the adoption of emerging and mature health IT standards to further align existing and emerging standards and implementation guidance with strategic healthcare policy goals to achieve improved health outcomes for people everywhere.
2.3 With the expansion of data and information exchange partners, along with the shift to value-based care, a broader range of data types have become available to inform on more complex and integrated health and care decisions, including data pertaining to the social determinants of health.
3 Insight – Standards Implementation
3.0 Health and healthcare organizations seeking to acquire or improve their health information systems need a convenient, reliable way of specifying a level of compliance to standards sufficient to achieve efficient interoperability for digital and data modernization.
3.1 Some standards development organization (SDO) entities create standards. Others bundle complementary standards into profiles that are used to define a specific function or use case. This provides implementation guidance that describes how multiple standards can be used together to support interoperable information exchange.
3.2 The different SDOs generally follow shared principles based on developing standards through a multi-stakeholder, consensus-based process to respond to a specific industry or market need.
4 Insight – Testing and Conformance
4.0 Organizations like the Global Consortium for eHealth Interoperability, which was co-founded by HIMSS, IHE International, and HL7 International, work to amplify and align the work of organizations like IHE and HL7 to increase the adoption of emerging and mature health IT standards. The consortium's primary goal is to coordinate work with governments and national ministries of health to further align existing and emerging standards and implementation guidance with strategic healthcare policy goals to achieve improved health outcomes for people everywhere.
5 Insight – Interoperability Ecosystem
5.0 An efficient interoperability ecosystem provides an information infrastructure that uses technical standards, policies, and protocols to enable seamless and secure capture, discovery, exchange, and utilization of health information.
Interoperability Playbook
Follow these best practices to make sure your standards-based implementation requirements are solid.
Summary of Plays
- Build awareness and knowledge of interoperability definitions, types, standards, standards-based implementation, and standards testing and conformance.
- Gauge the impact of interoperability by using the capabilities mapping tool for assessing, defining, supporting, and enabling capabilities for interoperability readiness across your organization.
- Develop an information infrastructure that includes all interoperability types, applicable standards, guides, and profiles.
- Choose standards that have been vetted by rigorous testing and conformance efforts.
- Build types and standards into your organization's interoperability ecosystem one use case at a time (e.g. the Info-Tech Social Determinants of Health blueprint).
Blueprint benefits
Developing and deploying world-class interoperating data and analytics exchange to meet today's and tomorrow's health challenges across health and care ecosystem landscapes. This includes all communities served at the individual, patient, and population levels.
Focusing on five key priorities that are interconnected and equally important to reaching the future interoperable state:
- Building the Right Foundation: Improving data exchange infrastructure, collection, analysis, and sharing across health and healthcare organization information networks.
- Accelerating Data for Action: Tapping into more data sources, promoting health equity, and increasing capacities for scalable outbreak response, nowcasting, forecasting, scenario modeling, and predictive analytics in real-time.
- Developing a State-of-the-Art Workforce: Using next-generation skills for actionable health and care insights.
- Supporting and Extending Partnerships: Breaking down silos, ensuring transparency, addressing policy challenges, and solving problems together.
- Managing Change and Governance: Making sure resources are used wisely, monitoring progress, and supporting strategic innovation for new ways of thinking and working.
Info-Tech offers various levels of support to best suit your needs
DIY Toolkit
“Our team has already made this critical project a priority, and we have the time and capability, but some guidance along the way would be helpful.”
Guided Implementation
“Our team knows that we need to fix a process, but we need assistance to determine where to focus. Some check-ins along the way would help keep us on track.”
Workshop
“We need to hit the ground running and get this project kicked off immediately. Our team has the ability to take this over once we get a framework and strategy in place.”
Consulting
“Our team does not have the time or the knowledge to take this project on. We need assistance through the entirety of this project.”
Diagnostics and consistent frameworks used throughout all four options
Additional Support
If you would like additional support, have our analysts guide you through other phases as part of an Info-Tech Workshop.
To accelerate this project, engage your IT team in an Info-Tech workshop with an Info-Tech analyst team.
Info-Tech analysts will join you and your team at your location or welcome you to Info-Tech's historic Toronto office to participate in an innovative onsite workshop.
Contact your account representative for more information.
workshops@infotech.com 1-888-670-8889
The following are sample activities that will be conducted by Info-Tech analysts with your team:
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Click here to access the Capability Mapping Tool in the Reference Architecture |
Click here to access The Role of SDOH in Value-Based Care Delivery blueprint |
Capability Mapping |
Use Case Implementation |
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Use the capability mapping tool as an interoperability readiness assessment process. |
Build types and standards into your organization's interoperability ecosystem one use case at a time. |
Interoperability defined 1.1
What is interoperability...
Leading industry-wide definitions
- Healthcare Information and Management Systems Society (HIMSS)
- The ability of different information systems, devices, and applications (systems) to access, exchange, integrate, and cooperatively use data in a coordinated manner, within and across organizational, regional, and national boundaries, to provide timely and seamless portability of information and optimize the health of individuals and populations globally.
- Office of the National Coordinator For Health IT (ONC)
- The ability of two or more systems to exchange health information and use the information once it is received.
- American Health Information Management Association (AHIMA)
- The ability to communicate and exchange data accurately, effectively, securely, and consistently with different information technology systems, software applications, and networks in various settings, and exchange data such that clinical or operational purpose and meaning of the data are preserved and unaltered.
- Institute of Electrical and Electronics Engineers (IEEE)
- The ability of two or more systems or components to exchange information and to use the information that has been exchanged.
01 Info-Tech Play
Build awareness and knowledge of interoperability definitions, types, standards, standards-based implementation, and standards testing and conformance efforts.
…and why is it important?
Info-Tech Insight
Standards-based Interoperability in health and healthcare organizations provides timely, safe, and secure access, integration, and use of electronic health data so that it can be used to optimize health outcomes for individuals and populations.
"You can't manage what you can't measure."
- Peter Drucker
"In public health, we can't do anything without surveillance. That's where public health begins."
- David Satcher, MD, PhD, Director, CDC 1993–1998; qtd. In CDC, Sept. 2022
Interoperability defined 1.2
Four types of interoperability
Source: Healthcare IT News, 2019
Interoperability is a journey, not a destination
1.1 Info-Tech Insight
Health and healthcare organizations prioritizing interoperability and standards at all levels will see improvements in data access, integration, management, retrieval of data and documents, scientific staff productivity, IT efficiencies, cost optimization, and data exchange capabilities, ensuring quick, safe and secure gathering, analyzing, and sharing of electronic health information in ways that follow all industry and HIPAA protocols.
1.2 Info-Tech Insight
Standards-based interoperable HIT solutions are becoming fundamental building blocks driving digital transformation, enabling financial efficiencies, and supporting standards development as well as the implementation, operation, and use of standards-based HIT solutions – specifically for services integration, cloud computing, cybersecurity, and information safety.
02 Info-Tech Play
Gauge the impact of interoperability by using the Info-Tech capabilities mapping tool for assessing defining, supporting, and enabling capabilities for interoperability readiness across your organization.
Interoperability defined 1.3
Are "health information exchange" and "data sharing" the same thing?
"Health information exchange"
United States/Canada
"Data sharing"
European Union
In the United States and Canada, the sharing of health information between entities is referred to as health information exchange. In the European Union, it is often referred to as data sharing.
Overview: Health information exchange, or HIE, provides the capability to electronically move clinical information among disparate health and healthcare organization information systems and maintain the meaning of the information being exchanged.
The goal: Health information exchange aims to facilitate access to and retrieval of clinical data to provide safe, timely, efficient, effective, and equitable patient-centered care. HIE can also be used by public health authorities to assist in the analysis of the health of populations.
The term: The Healthcare Information and Management Systems Society (HIMSS) generally defines the term HIE as either a verb or a noun.
Verb: The electronic sharing of health-related data between two or more organizations facilitated by applied standards for use by a variety of stakeholders to inform health and care.
Noun: Organizations within the United States that provide health information exchange technology and services at a state, regional, or national level and often work directly with communities to promote secure sharing of health data.
Source: HIMSS, 2020
Standards development
Making sense of so many standards.
Standards Development
- There are over 40 different types of standards development organizations (SDOs) in the health IT arena. Examples include health level seven (HL7) and systematized nomenclature of medicine (SNOMED).
Accreditation
- An organization may be accredited by the American National Standards Institute (ANSI) or the International Organization for Standardization (ISO).
Types of Standards
- In order to understand the types of health data standards available for use, these standards are organized into the following specific categories:
- Vocabulary/Terminology
- Content
- Transport
- Privacy and Security
- Identifiers
The Value of Interoperability Standards
2.0 Info-Tech Insight
Standards provide common vocabulary, code sets, structure, and guidelines that enable interoperability between systems and/or devices.
2.1 Info-Tech Insight
In order to seamlessly ingest and curate information without effort about an individual or population and improve the overall coordination and delivery of healthcare services, beneficiary services, or population-based interventions, standards permit clinicians, labs, hospitals, pharmacies, payors, patients, health information exchanges, healthcare services organizations, and public health organizations to share data regardless of application or market supplier.
Which standards do I apply for what purpose?
Associating types of standards with types of interoperability.
Foundational
- Reference Architecture
- Capabilities Mapping
- Enterprise Architecture
- Business
- Applications
- Data
- Technical
- Infrastructure
- Example: Data Lakehouse
- Retrieval
- Storage
- Curation
- Analytics
- Reporting
- Exchange
- Example: Data Lakehouse
Structural
- Content Standards
- Transport Standards
Semantic
- Vocabulary/Terminology Standards
- Code Sets
- Classification Systems
Organizational
- Privacy and Security Standards
- Identifier Standards
- Governance
- Shared Consent
- Trust vs. Commons
- Workflows
- Other Considerations
- Policy/Social/Legal
2.2 Info-Tech Insight
Interoperability standards development works to increase the adoption of emerging and mature health IT standards and facilitates the coordination of work with health and healthcare organizations to further align existing and emerging standards and implementation guidance with strategic healthcare policy goals to achieve improved health outcomes for people everywhere.
2.3 Info-Tech Insight
With the expansion of data and information exchange partners, along with the shift to value-based care, has come a broader range of data types that are available to inform on more complex and integrated health and care decisions. This includes data pertaining to the social determinants of health, which can include an individual's housing status, access to reliable transportation and high-quality care, and level of food security.
Foundational interoperability
Also known as simple transport, foundational interoperability is the most basic level and refers to an organization's system or software capability to exchange data with another system. At this level, systems can securely communicate and receive data from other systems assuming a basic level of infrastructure is in place for safe and secure transport. Capabilities mapping provides a process to assess an organization's readiness for interoperable information exchange. While enterprise architecture defines, organizes, standardizes, and documents the entire architecture and key elements of an organization within which interoperability types and standards are identified and specified in the workflow.
Foundational
- Reference Architecture
- Capabilities Mapping
- Enterprise Architecture
- Business
- Applications
- Data
- Technical
- Infrastructure
- Example: Data Lakehouse
- Retrieval
- Storage
- Curation
- Analytics
- Reporting
- Exchange
- Example: Data Lakehouse
Click Here to Access the Capability Mapping Tool for Foundational Interoperability
In business reference architecture, the primary view of an organization is known as a business capability map. A model that forms the basis of strategic planning discussions for foundational interoperability, the business capability map provides details that help the business architecture practitioner direct attention to a specific area of the business for further assessment. | |
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Defining Capabilities: | The activities that define the organization's business. They support specific core functions including assessment, policy development, and assurance. |
Supporting Capabilities: | Business-aligned capabilities (e.g. data strategy, integration, management, and architecture) that realize the organization's defining core functions and essential services. |
Enabling Capabilities: | Cross-cutting capabilities (e.g. governance, privacy and security, and risk management) that support both shared and defining capabilities. Enables capabilities to facilitate foundational interoperability in business decision making on multiple levels. |
Enterprise architecture is a discipline that defines, organizes, standardizes, and documents the entire architecture and key elements of an organization. | |
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Business Architecture: | Defines the business strategy, governance, organization, and key business processes of the organization. |
Applications Architecture: | Provides a blueprint for the individual systems to be deployed, the interactions between the application systems, and their relationships to the core business processes of the organization, with the frameworks for services to be exposed as business functions for integration. |
Data Architecture: | The set of rules, policies, standards, and models that govern and define the type of data collected and how it is used, stored, managed, and integrated within an organization and its database systems. |
Technical Architecture: | Describes the hardware, software, and network infrastructure needed to support the deployment of core, mission-critical applications |
Infrastructure is a set of IT components that are the foundation of an IT service environment – typically refers to the physical environment, including software, hardware, and network components necessary for interoperable data and information exchange. |
Structural interoperability
The standardization of data to a particular format, syntax, and organization of data exchange, including the data field level, to enable machine-readable interpretation by multiple document management systems or devices. At this level of interoperability, data is categorized and organized into a specific order to ensure the receiving system can automatically detect predetermined data fields.
Structural
- Content Standards
- Transport Standards
Content standards relate to the data content contained within exchanges of information. They define the structure and organization of the electronic message or document's content. This standard category also includes the definition of common sets of data for specific message types. | |
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Consolidated CDA (C-CDA): | A library of CDA templates, incorporating and harmonizing previous efforts from HL7, IHE, and Health Information Technology Standards Panel (HITSP). |
HL7's Version 2.x (V2): | A widely implemented messaging standard that allows the exchange of clinical data between systems. It is designed to support a central patient care system as well as a more distributed environment where data resides in departmental systems. |
HL7 Version 3 Clinical Document Architecture (CDA®): | An XML-based document markup standard that specifies the structure and semantics of "clinical documents" for the purpose of exchange between healthcare providers and patients. |
Transport standards address the format of messages exchanged between computer systems, document architecture, clinical templates, user interface and patient data linkage. Standards center on "push" and "pull" methods for exchanging health information. |
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The standard for the communication and management of medical imaging information and related data. DICOM enables the transfer of medical images across systems and facilitates the development and expansion of picture archiving and communication systems. |
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Defines a set of standards and protocols to allow participants to send authenticated, encrypted health information directly to known, trusted recipients over the internet. Two primary specifications are the Applicability Statement for Secure Health Transport v1.3 and the XDR and XDM for Direct Messaging. |
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An HL7 standard for exchanging healthcare information electronically. The basic building blocks of FHIR are "resources," which describe exchangeable health data formats and elements. FHIR also provides standardization for application programming interfaces (APIs). |
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IHE: |
IHE provides several specifications, including public health profiles, that can be used in the exchange of health information. |
Not an exhaustive list of standards. For illustrative purposes only.
Semantic interoperability
The ability to automatically interpret the information exchanged accurately, as it was originally intended, and without changing its meaning in order to produce useful results as defined by the end-users of both systems.
Semantic
- Vocabulary/Terminology Standards
- Code Sets
- Classification Systems
Vocabulary/terminology standards address the ability to represent concepts in an unambiguous manner between a sender and receiver of information, a fundamental requirement for effective communication. Health information systems that communicate with each other rely on structured vocabularies, terminologies, code sets, and classification systems to represent health concepts. |
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A code set, maintained by the American Medical Association (AMA), used to bill outpatient and office procedures. |
CVX is a HL7 standard code set used for immunization messages. CVX includes approximately 200 active and inactive vaccine terms for the United States (US). It also indicates a vaccine's current availability and the last update time for the vaccine code. Inactive vaccine codes allow users to transmit historical immunization data. |
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A set of healthcare procedure codes based on CPT that is used for Medicare reimbursement. |
The Interoperability Standards Advisory (ISA) process represents the model by which the Office of the National Coordinator for Health Information Technology (ONC) coordinates the identification, assessment, and determination of "recognized" interoperability standards and implementation specifications for industry use to fulfill specific clinical health IT interoperability needs. |
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ICD-10 and ICD-11: |
The International Statistical Classification of Diseases and Related Health Problems (ICD) is a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. The 11th revision replaces the ICD-10 in January 2022. |
Maintained by the U.S. Food and Drug Administration, NDC provides a list of all drugs manufactured, prepared, propagated, compounded or processed for commercial distribution. |
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The Systematized Nomenclature of Medicine-Clinical Terms is a comprehensive clinical health terminology product. It enables the consistent, processable representation of clinical content in electronic health records (EHRs). These codes often represent the "answer" for a test or measurement to the LOINC "question" code. |
A unified language of radiology terms for standardized indexing and retrieval of radiology information resources, managed by the Radiological Society of North America. It unifies and supplements other lexicons and standards, such as SNOMED-Clinical Terms and DICOM. |
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A terminology used to normalize names for clinical drugs and links its names to many of the drug vocabularies commonly used in pharmacy management and drug interaction software. By providing links between these vocabularies, RxNorm can mediate messages between systems not using the same software and vocabulary. |
A code system intended to include all units of measures used in international science, engineering, and business to facilitate unambiguous electronic communication of quantities together with their units. |
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Logical Observation Identifiers Names and Codes is a universal code system for identifying health measurements, observations, and documents. These codes represent the "question" for a test or measurement. LOINC codes can be grouped into laboratory and clinical tests, measurements, and observations. |
Not an exhaustive list of standards. For illustrative purposes only.
Organizational interoperability
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, entities, and individuals. These components enable shared consent, trust, and integrated end-user processes and workflows.
Organizational
- Privacy and Security Standards
- Identifier Standards
- Governance
- Shared Consent
- Trust vs. Commons
- Workflows
- Other Considerations
- Policy
- Social
- Legal
Privacy standards aim to protect an individual's (or organization's) right to determine whether, what, when, by whom, and for what purpose their personal health information is collected, accessed, used, or disclosed. Security standards define a set of administrative, physical, and technical actions to protect the confidentiality, availability, and integrity of health information. |
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In the U.S., the Health Insurance Portability and Accountability Act (HIPAA) outlines standards that safeguard the privacy and security of protected health information. |
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Establishes national standards to protect individual's medical records and other personal health information. It applies to health plans, healthcare clearinghouses, and healthcare providers that conduct certain healthcare transactions electrically. The rule applies safeguards to protect the privacy of personal health information and sets limits and conditions on the uses and disclosures of such information without patient authorization. The rule also gives patients rights over their own health information, including the right to examine and obtain a copy of their records, and to request corrections. |
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Sets national standards for protecting the confidentiality, integrity, and availability of electronically protected health information. The rule addresses the technical and non-technical safeguards that "covered entities" must have in place to secure an individual's electronic protected health information. |
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In Europe, the General Data Protection Regulation (GDPR) outlines privacy and security regulations for all processing and storage of data relating to data subjects (or people) in the European Union (EU). This regulation extends to health information and across any organization that may process or store data on these subjects. |
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Organizations, entities, and individuals use identifier standards to uniquely identify patients or providers. |
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Enterprise Master Patient Index (EMPI): |
A data registry used across a healthcare organization to maintain consistent and accurate data on the patients treated and managed within its departments. |
Medical Record Number (MRN): |
An organization-specific code used as systematic documentation of a patient's history and care during a hospital stay. |
National Provider ID (NPI): |
A unique 10-digit number for a healthcare provider to create a standard identification. These NPIs are included in the free NPI Registry. |
Object ID (OID): |
A globally unique ISO identifier and a preferred scheme for unique identifiers in HL7. |
Not an exhaustive list of standards. For illustrative purposes only.
Standards implementation guides and profiles
Standards describe and constrain what and how data moves.
Implementation guides: Defined
Implementation guides describe how to implement standards for what types of use cases. They specify:
- Which way a standard is to be applied (organizational interoperability).
- How to structure the data consistently (structural interoperability).
- What vocabulary to use (semantic interoperability).
Implementation guides: Benefits
Implementation guides like IHE Profiles and ONC's ISA provide:
- A common language to identify and specify health and healthcare organizations' data integration and health IT needs.
- Precise definitions and implementation path for developers of how to implement standards to align with business needs.
- Standards that have been carefully documented, reviewed, tested, and supported by industry partners.
- IT purchaser tools that reduce the complexity, cost, and anxiety of implementing interoperable systems.
IHE profiles organize and leverage the integration capabilities that can be achieved by the coordinated implementation of communication standards, such as DICOM, HL7 W3C, and security standards.
The Value of Standards Implementation Guides and Profiles
3.0 Info-Tech Insight
Health and healthcare organizations seeking to acquire or improve their health information systems need a convenient, reliable way to specify a sufficient level of compliance to standards to achieve efficient interoperability for digital transformation and data modernization.
3.1 Info-Tech Insight
Some standards development organization (SDO) entities create standards. Others bundle complementary standards into profiles that are used to define a specific function or use case. This provides implementation guidance that describes how multiple standards can be used together to support interoperable health information exchange.
3.2 Info-Tech Insight
The different SDOs generally follow shared principles based on developing standards through a multi-stakeholder, consensus-based process to respond to a specific industry or market needs.
03 Info-Tech Play
Develop an information infrastructure that includes all interoperability types, applicable standards, guides, and profiles.
Standards testing and conformance
Testing and conformance: Defined
The adoption and implementation of standards involve a testing ecosystem that spans standards development, implementation, and feedback from real-world testing into the development process to support continuous improvement.
Testing and conformance: Efforts
There are various testing and compliance efforts that support advancing health IT interoperability: |
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IHE International administers the IHE Conformity Assessment Scheme, which forms the basis for IHE Conformity Assessment Programs and any official certification of conformance to IHE Profiles associated with such testing programs. IHE International authorizes designated test laboratories accredited under this standard to assess the conformity of products with selected IHE profiles. | |
The program was developed to test compliance with HIE standards as required by the eHealth Exchange Coordinating Committee for onboarding to the eHealth Exchange network. Its purpose is to enable organizations that wish to participate in the exchange to validate the compliance of their health IT with the eHealth Exchange Performance and service specifications. | |
These events provide hands-on FHIR development and testing opportunities held in conjunction with working group meetings. Participants engage in development and testing, working directly with other FHIR developers and senior members of the FHIR standards development team. | |
A cross-vendor, supervised, and structured testing event where the industry tests implementation of IHE Profiles and other standards to successful standards implementation and use. All tests are evaluated on interoperability and conformance to IHE Profiles found in IHE's technical frameworks. The test floor is overseen by IHE's technical project managers, providing a safe, neutral test environment and an opportunity for industry collaboration and problem resolution. | |
Office of the National Coordinator for Health IT Health IT Certification Program: |
A voluntary certification program established by the Office of the National Coordinator for Health IT (ONC) to provide for the certification of health IT. Requirements for certification are established by standards, implementation specifications, and certification criteria adopted by the ONC secretary. The program supports the availability of certified health IT for its encouraged and required use under other federal, state, and private programs. The program is run as a third-party product conformity assessment scheme for health IT based on the principles of the ISO and International Electrotechnical Commission framework. |
The Value of Testing and Conformance
4.0 Info-Tech Insight
Organizations like the Global Consortium for eHealth Interoperability, which was co-founded by HIMSS, IHE International, and HL7 International, work to amplify and align the work of organizations like IHE and HL7 to increase the adoption of emerging and mature health IT standards. The consortium's primary goal is to coordinate work with governments and national ministries of health to further align existing and emerging standards and implementation guidance with strategic healthcare policy goals to achieve improved health outcomes for people everywhere.
04 Info-Tech Play
Choose standards that have been vetted by rigorous testing and conformance efforts.
Roadblocks to interoperability (1)
2 Key Issues
Two key issues, readiness and data sharing challenges, are impeding health and healthcare organizations from achieving interoperability.
3 of the Biggest Challenges
Among stakeholders in the health and healthcare industry, the lack of data standardization, technical interoperability, and data quality were the biggest challenges to health data sharing between data-sharing entities.
Top 5 Barriers
The top five barriers to interoperability readiness and implementation among health and healthcare executive management and senior leadership include competing priorities, time for implementation, lack of staff, knowledge of requirements, and lack of funding.
(1) Source: eHealth Initiative, "Survey Results: Readiness for the ONC and CMS Interoperability Rules," 2020
Incentives to participate
Creating an interoperable health IT ecosystem is the key to unlocking the future of health and healthcare.
Data Exchange Facilitators
Data standardization, technical interoperability, and data quality are the biggest opportunities for health data sharing between data-sharing entities.
Readiness Facilitators
- Moving from a siloed to an ecosystem approach is a significant change in service delivery.
- Interoperability is the key to delivering end-to-end processes in the health ecosystem by integrating multiple solutions across organizational boundaries to deliver the best possible health and care at the individual and population levels.
- It requires changes in health and care service delivery around design, application development, operational support, roles, skills, accountabilities, partnerships, governance, and security.
For illustrative purposes only. Not an exhaustive list of facilitators, benefits, and uses.
Workflow considerations and guidance
Privacy, security, and ensuring data quality.
Ensuring privacy and security
Regulations such as the General Data Protection Regulation (GDPR) in the EU, the Health Insurance Portability and Accountability Act (HIPAA) in the U.S., and various other national and state laws and regulations establish privacy and security requirements to safeguard the creation and receiving, maintenance, and transmittal of health information maintained by health and healthcare organizations and systems.
Privacy and security considerations may include the following:
- Implementing Data Use and Reciprocal Support Agreements (DURSA) – also known as trust agreements – with health systems and other stakeholders.
- Data access and exchange controls.
- Standard privacy and security policies and procedures that govern data protection and use.
- Data encryption guidelines for exchange between data-sharing organizations.
- Administrative, physical, and technical assurances for maintaining confidentiality, integrity, and availability of the data aligned with state and national laws and regulations.
Data quality considerations
In order to ensure that the information received from one or many sources can be trusted and that it is accurate and complete, efforts by organizations to maintain high-quality data may include the following:
- Ensuring structural and semantic interoperability so that data are structured and coded with standardized terminology and styles where possible, to be leveraged in a machine-readable format for analysis and interpretation.
- Documentation communicates in a way such that the clinical or operational purpose and meaning of the data are preserved, unaltered, and understood by human end-users.
Info-Tech Insight
Level 4 organizational interoperability must consider alignment with external organizations and work toward enabling shared consent, trust, and safe, secure, seamless, and timely integrated end-to-end user processes and workflows.
Interoperability Ecosystem
Interoperability ecosystem
Exchange partners and data sources.
The interoperability ecosystem accesses and exchanges all forms of health and health-related information.
Health and healthcare organizations, hospitals, health systems, information exchanges, registries, researchers, payers, providers, laboratories, pharmacies, patients, and suppliers, among a host of others, are potential stakeholders within the interoperability ecosystem. Each is involved in the creation, exchange, and use of data and health information.
05 Info-Tech Play
Build types and standards into your organization's interoperability ecosystem one use case at a time (e.g. the Info-Tech Social Determinants of Health blueprint).
The value of an interoperability ecosystem
5.0 Info-Tech Insight
An efficient interoperability ecosystem provides an information infrastructure that uses technical standards, policies, and protocols to enable seamless and secure capture, discovery, exchange, and utilization of health information. With the expansion of data and information exchange partners, along with the shift to value-based care, has come a broader range of data types that are available to inform on more complex and integrated health and care decisions, including device data, patient-generated data, and data pertaining to the social determinants of health, which can include an individual's housing status, access to reliable transportation and high-quality care, and level of food security.
Network architectures for interoperability
There are three primary types of exchange network architecture used to coordinate the exchange of health information across entities.
Centralized
Patient data are collected and stored in a centralized repository, data warehouse, or other databases. The exchange organization has full control over the data, including the ability to authenticate, authorize, and record transactions among participants.
Federated
Interconnected but independent databases allow for data sharing and exchange and grant users' access to the information only when needed.
Hybrid
Incorporates variations of federated and centralized architectures to harness the advantages of both. These are becoming common as various combinations of available services are implemented.
An important technical development that has expanded exchange partners and data sources is the emergence of healthcare APIs. APIs outline a set of clearly defined specifications to allow for one software application to build on the data and functionality of another application, without needing to understand its system design. APIs are already ubiquitous in today's web economy and will play an essential role with respect to fueling healthcare interoperability for person-centered care.
Source: HIMSS 2022
Interoperability modernization – data lakehouse
Solution Architecture
Data, Application, and Technology Layers
Info-Tech Insight
A data lakehouse is a modern hybrid, open data management architecture that takes the best concepts from both the data science focus of a data lake and the analytics power of a data warehouse and puts them together while trying to eliminate the unsupported and proprietary limitations of both models. A data lakehouse offers one single source of truth for analytics and simplifies enterprise data infrastructure at a time when machine learning is poised to disrupt every industry.
Interoperability modernization – network architecture
Solution Architecture
Data, Application, and Technology Layers
Info-Tech Insight
A data lakehouse infrastructure provides a modern architected, single-source platform solution for safe, secure, and governed data ingestion, unified data analytics, and manual, automated, and streaming data sharing and accessibility.
Public health and healthcare interoperating information exchange system
Managed interoperability
"Advancing interoperability is now an essential part of most health care activities ranging from health equity to public health emergency response."
– Healthit.gov, "Interoperability," 2019
Types of HIE organizations
There are several different types of health information exchanges (HIEs) currently operating across the US and its territories.
An HIE organization oversees and governs the exchange of health-related information
among organizations according to nationally recognized standards. The purpose of a health information exchange organization is to perform oversight, governance, and data curation functions for information exchange.
Types of HIEs: |
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Hybrid: |
Often collaborations between organizations, such as an ACO and a vendor network, within a state or region. The Kentucky Health Information Exchange is an example of a hybrid model. |
Private/Proprietary: |
Concentrate on a single community or network, often based within a single organization, and include overall management, finance and governance. Examples may include hospital/integrated delivery system networks, payer-based HIEs, and disease-specific HIEs. Some software vendors have also established an HIE network for their clients across the U.S. Additionally, the industry may see other evolving entities such as accountable care organizations (ACOs) supporting information exchange. |
Regional/Community: |
Inter-organizational and depend on a variety of funding sources. Most are not-for-profit. Indiana Health Information Exchange and Chesapeake Regional Information System for Our Patients are examples of regional HIEs. |
Statewide: |
Run by the governments of their respective states or maybe the state's designated entity. Some state-wide (and regional) HIEs use an umbrella approach and serve as the aggregator for disparate private health information exchanges. Statewide Health Information Network for New York and Arizona's Health Current are examples of state-wide HIEs. |
Nationwide/Global: |
The landscape of U.S.-based networks and frameworks enables interoperable, nationwide, and global health information exchange via a variety of methods and collaborations. |
Forms of health information exchange
Accessing and securely sharing medical information electronically.
Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other healthcare providers, and patients to appropriately access and securely share a patient's vital medical information electronically – improving the speed, quality, safety, and cost of patient care.
There are currently three key forms of health information exchange:
- Directed Exchange
- Ability to send and receive secure information electronically between care providers to support coordinated care.
- Query-Based Exchange
- Ability for providers to find and/or request information on a patient from other providers, often used for unplanned care.
- Consumer Mediated Exchange
- Ability for patients to aggregate and control the use of their health information among providers.
Click here to learn more about the forms of Health Information Exchange
Source: ONC, "What is HIE?," 2020
Use cases
Sources and examples
Standards and Technology:
- Office of the National Coordinator (ONC) Interoperability Standards Advisory (ISA)
- US Core Data for Interoperability (USCDI)
- ONC Health IT Certification Program
Investments:
- The Sequoia Project Interoperability Matters Initiative
- LEAP in Health IT
Investments/Policy:
- ONC Trusted Exchange Framework and Common Agreement (TEFCA)
Policy:
- Information blocking
Trends:
- Interoperability participation and methods of exchange among hospitals
STANDARDS AND TECHNOLOGY
Use Case: ONC Interoperability Standards Advisory
Identification, assessment, and public awareness of interoperability standards and implementation specifications.
INDUSTRY: U.S. Government
SOURCE:
Office of the National Coordinator for Health Information Technology (ONC)
Interoperability Standards Advisory (ISA)
The Interoperability Standards Advisory (ISA) process represents the model by which the Office of the National Coordinator for Health Information Technology (ONC) coordinates the identification, assessment, and public awareness of interoperability standards and implementation specifications that can be used by the United States healthcare industry to address specific interoperability needs including, but not limited to, interoperability for clinical, public health, and research purposes. ONC encourages all stakeholders to implement and use the standards and implementation specifications identified in the ISA as applicable to the specific interoperability needs they seek to address. Furthermore, ONC encourages that further pilot testing and industry experience be sought with respect to standards and implementation specifications identified as "emerging" in the ISA. For historical background on the ISA please review prior ISA publications.
Source: ONC 2019, 2022
STANDARDS AND TECHNOLOGY
Use Case: US Core Data for Interoperability
Standardized health data classes and elements for interoperable health information exchange.
INDUSTRY: U.S. Government
SOURCE: Office of the National Coordinator for Health Information Technology (ONC)
US Core Data for Interoperability (USCDI)
The United States Core Data for Interoperability (USCDI) is a standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange. Review the USCDI Fact Sheet to learn more.
A USCDI "data class" is an aggregation of various data elements by a common theme or use case.
A USCDI "data element" is the most granular level at which a piece of data is exchanged.
For example, date of birth is a data element rather than its component day, month, or year, because date of birth is the unit of exchange.
Source: ONC 2022
USCDI v3 Summary of Data Classes and Data Elements
STANDARDS AND TECHNOLOGY
Use Case: ONC Health IT Certification Program
ONC Health IT Certification Program Progress
Use • Empowerment • Interoperability
INDUSTRY: Government
SOURCE: Office of the National Coordinator for Health Information Technology (ONC)
About the Program
The Office of the National Coordinator for Health Information Technology (ONC) Health IT Certification Program is a voluntary certification program established by the ONC to provide for the certification of health IT. Requirements for certification are established by standards, implementation specifications, and certification criteria adopted by the Secretary of the Department of Health and Human Services (HHS).
INVESTMENTS
Use Case: The Sequoia Project Interoperability Matters Initiative
Interoperability Matters Initiative
Creating practical solutions to health data exchange challenges.
INDUSTRY: Government
SOURCE: The Sequoia Project
Important interoperability issues to tackleAdditional call-out areas:
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INVESTMENTS
Use Case: LEAP in Health IT
Addressing fast emerging challenges that inhibit the development, use, and advancement of interoperability in health IT.
INDUSTRY: US Government
SOURCE: Office of the National Coordinator for Health Information Technology (ONC)
Leading Edge Acceleration Projects (LEAP) in Health Information Technology (Health IT)
LEAP in Health IT projects tackle the creation of new standards, methods, and tools to improve care delivery and advance research capabilities. The LEAP in Health IT program addresses fast emerging challenges that inhibit the development, use, and advancement of interoperable health IT.
Organization |
Project Description |
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AllianceChicago's Aligning Housing and Healthcare project leverages HL7® FHIR® to enable service providers to integrate and coordinate services to better address SDOH for individuals experiencing homelessness. |
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MedStar Health Research Institute's Equity Engines project focuses on developing the infrastructure and standards-based patient-generated health data (PGHD) technologies needed to demonstrate the scalable use of equity-enhancing PGHD for clinical care and research from the point-of-care to the researcher. |
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DARTNet Institute's Semantic Interoperability for Electronic Health Data Using the Layered Schemas Architecture project is focused on building a data processing framework to enable semantic harmonization of health data that can be used for artificial intelligence (AI) training and research. |
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The Chesapeake Regional Information System for our Patients (CRISP) and American College of Cardiology |
The CRISP and American College of Cardiology's Development and Testing of Data Sharing Functionality for Health System Participating in National Cardiovascular Disease Registries project aims to advance the health IT ecosystem through the accelerated adoption of modern standards, including the acquisition of clinical data for registry submissions and the use of data to improve care decisions. |
San Diego Regional Health Information Exchange's Scalable Consent Framework for the Advancement of Interoperability with FHIR-based APIs project focuses on software development and research of standards, use case and community testing, production deployment, and consent management. An implementation guide and package of open-source prototypes and content also will be developed and shared to assist partners. |
Source: ONC, "Leading Edge Acceleration Projects in Health Information Technology"
INVESTMENTS & POLICY
Use Case: ONC TEFCA
A universal policy and technical floor for nationwide interoperability.
INDUSTRY: US Government
SOURCE: Office of the National Coordinator for Health Information Technology (ONC)
Trusted Exchange Framework Common Agreement (TEFCA)
The Trusted Exchange Framework and Common Agreement (TEFCA) establishes a universal policy and technical floor for nationwide interoperability; simplifies connectivity for organizations to securely exchange information to improve patient care, enhance the welfare of populations, and generate health care value; and enables individuals to gather their healthcare information.
The Common Agreement establishes the infrastructure model and the governing approach for users in different networks to securely share basic clinical information under commonly agreed-upon expectations and rules.
Source: ONC, Trusted Exchange Framework and Common Agreement (TEFCA), 2022
Additional Resources
- A User's Guide to Understanding TEFCA
- Common Agreement for Nationwide Health Information Interoperability - Version 1
- Trusted Exchange Framework – Final
- Data Use and Reciprocal Support Agreement (DURSA)
- 21st Century Cures Act (Cures Act)
Glossary of Terms
POLICY
Use Case: Information Blocking
Identifying reasonable and necessary activities that do not constitute information blocking.
INDUSTRY: US Government
SOURCE: Office of the National Coordinator for Health Information Technology (ONC)
Information blocking
Information blocking is a practice by a healthcare "actor," except as required by law or specified in an information blocking exception, that is likely to interfere with the access, exchange, or use of electronic health information (EHI).
– 21st Century Cures Act, 2016
Source: ONC, Information Blocking, 2022
To whom does information blocking apply?
The 21st Century Cures Act (Cures Act) applies the law to healthcare providers, health IT developers of certified health IT, and health information exchanges (HIEs)/health information networks (HINs).
The Cures Act also establishes two different "knowledge" standards for actors' practices within the statute's definition of "information blocking." For health IT developers of certified health IT and HIEs/HINs, the law applies the standard of whether they know, or should know, that a practice is likely to interfere with the access, exchange, or use of EHI. For healthcare providers, the law applies the standard of whether they know that the practice is unreasonable and is likely to interfere with the access, exchange, or use of EHI.
Information blocking exceptions
Eight information blocking exceptions were established in the 2020 Cures Act Final Rule. The exceptions are divided into two categories:
- Exceptions that involve not fulfilling requests to access, exchange, or use EHI
- Preventing Harm
- Privacy
- Security
- Infeasibility
- Health IT Performance
- Exceptions that involve procedures for fulfilling requests to access, exchange, or use EHI
- Licensing
- Fees
- Content and Manner
Additional Resources
Trends
Use Case: Interoperability Participation and Methods of Exchange among U.S. Hospitals
The current state of interoperability among hospitals and trends on participation in local, state, regional, or national information exchange networks.
INDUSTRY: Healthcare
SOURCE: American Hospital Association
Trends show progress in interoperable health information exchange among hospitals in the U.S.
Interoperable exchange of health information is critical for delivering appropriate care, reducing healthcare costs, and making healthcare more efficient.
Methods of information exchange include sending, receiving, querying/finding, and integrating patient health information.
Nearly all hospitals (91%) are now participating in some form of patient health information exchange and more than six in ten (62%) are participating in all forms of exchange via local, regional, state, and/or national health information exchange networks.
Percent of U.S. non-federal acute care hospitals engaging in electronic sharing of patient health information |
Hospital participation rates in national, state, regional, or local information exchange networks |
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Sources: AHA Annual Survey Information Technology Supplement; ONC Data Brief, No. 64, "Interoperability and Methods of Exchange among Hospitals in 2021" |
Info-Tech offers various levels of support to best suit your needs
DIY Toolkit
“Our team has already made this critical project a priority, and we have the time and capability, but some guidance along the way would be helpful.”
Guided Implementation
“Our team knows that we need to fix a process, but we need assistance to determine where to focus. Some check-ins along the way would help keep us on track.”
Workshop
“We need to hit the ground running and get this project kicked off immediately. Our team has the ability to take this over once we get a framework and strategy in place.”
Consulting
“Our team does not have the time or the knowledge to take this project on. We need assistance through the entirety of this project.”
Diagnostics and consistent frameworks used throughout all four options
Our research provides our members with the tools they need to succeed in an increasingly complex industry landscape
Industry Insights and Best Practices
- Industry-specific methodologies
- Business reference architectures
- Digital trends: the future of your industry
- Core technology research
- Peer benchmarking reports
Executive Peer Group Discussions
- Executive collaboration
- Peer-to-peer knowledge sharing
- High-impact discussion topics
Analyst and Advisory Services
- Digital maturity assessment
- Digital strategy
- Business-IT alignment
- Digital governance and execution
- Peer benchmarking
Capitalize on your industry membership to support your organization's value-based care transition
Industry research members have access to expert analysts, research, and tools.
Visualize the art of the possible |
Evolve your transition business strategy |
Execute with confidence |
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Additional support
If you would like additional support, have our analysts guide you through other phases as part of an Info-Tech workshop
To accelerate this project, engage your IT team in an Info-Tech workshop with an Info-Tech analyst team.
Info-Tech analysts will join you and your team at your location or welcome you to Info-Tech's historic Toronto office to participate in an innovative onsite workshop.
Contact your account representative for more information.
workshops@infotech.com 1-888-670-8889
The following are sample activities that will be conducted by Info-Tech analysts with your team:
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Click here to access the Capability Mapping Tool in the Reference Architecture | Click here to access The Role of SDOH in Value-Based Care Delivery blueprint |
Capability Mapping | Use Case Implementation |
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Use the capability mapping tool as an interoperability readiness assessment process. | Build types and standards into your organization's interoperability ecosystem one use case at a time. |
Bibliography
2022 Interoperability Standards Advisory. www.healthit.gov/isa/sites/isa/files/inline-files/2022-ISA-Reference-Edition.pdf.
"About the Interoperability Standards Advisory (ISA)." HealthIT.gov, n.d., www.healthit.gov/isa/about-isa.
"About the ONC Health IT Certification Program." HealthIT.gov, n.d., www.healthit.gov/topic/certification-ehrs/about-onc-health-it-certification-program.
AHIMA Public Policy Statement: Interoperability AHIMA's Position. www.ahima.org/media/qlkjsw5f/ahima-interoperability-public-policy-statement.pdf. Accessed 4 Nov. 2022.
"AHIMA Standards Fact Sheet: Standards and Systems Interoperability." AHIMA, n.d., https://bok.ahima.org/PdfView?oid=302334#:~:text=AHIMA%20supports%20the%20definition%20of%20interoperability%20developed%20in,ability%20to%20%3Ccapture%2C%20manage%2A%3E%2C%20communicate%20and%20exchange%20.
American Hospital Association (AHA). "AHA Healthcare IT Database: 2021 AHA Annual Survey Information Technology Supplement " www.ahadata.com/aha-healthcare-it-database.
American Medical Association. "CPT®." American Medical Association, 2019, www.ama-assn.org/practice-management/cpt.
"An Overview on Health Care Interoperability." Aegis Blog, May 19, 2016, www.aegisiscblog.com/overview-health-care-interoperability.html. Accessed 4 Nov. 2022.
"ANSI-DS 2019-01-100-2021 Applicability Statement for Secure Health Transport Version 1.3." Direct Trust, May 13, 2021, https://directtrust.app.box.com/s/p1dpmt9tkoa9ay7h3bmcwwo5jj0yrhw7.
ANSI. "Applicability Statement for Secure Health Transport." DirectTrust, May 13, 2021, https://directtrust.app.box.com/s/p1dpmt9tkoa9ay7h3bmcwwo5jj0yrhw7. Accessed 11 Oct. 2022.
ASTHO. "Developing a State Health Improvement Plan: Guidance and Resources - A Companion Document to ASTHO's State Health Assessment Guidance and Resources." www.astho.org/globalassets/pdf/accreditation/developing-a-state-health-improvement-plan-guidance-and-resources.pdf. Accessed 6 Oct. 2022.
"Auditing Actions on Health Information." HealthIT.gov, n.d., www.healthit.gov/test-method/auditing-actions-health-information. Accessed 4 Nov. 2022.
"Barriers to Health Data Sharing in the U.S. In 2020, by Healthcare Actor." Statista, www.statista.com/statistics/1314771/barriers-to-health-data-sharing-in-the-us-by-healthcare-actor/. Accessed 31 Oct. 2022.
"California Data Exchange Landscape." California Health and Human Services, July 1, 2022, www.chhs.ca.gov/wp-content/uploads/2022/07/3_CalHHS_DxF_California-Data-Exchange-Landscape_Final_v1_07-01-2022.pdf.
"CDC's Data Modernization Initiative." CDC, 11 Oct. 2022, https://www.cdc.gov/surveillance/projects/dmi-initiative/index.html#:~:text=CDC%E2%80%99s%20Data%20Modernization%20Initiative%20%28DMI%29%20is%20at%20the,data%20reporting%2C%20management%2C%20and%20analytics%20across%20public%20health.
Centers for Medicare & Medicaid Services (CMS). "HCPCS - General Information." CMS.gov n.d., www.cms.gov/Medicare/Coding/MedHCPCSGenInfo.
Centers for Medicare & Medicaid Services (CMS). "ICD-10." CMS.gov n.d., www.cms.gov/medicare/coding/icd10?redirect=/icd10.
"CHIME-KLAS Interoperability Report Finds Significant Gains in Access and Data Exchange." Healthcare IT - CHIME, 26 Jan. 2021, www.cio-chime.org/chime-klas-interoperability-report-finds-significant-gains-in-access-and-data-exchange/.
"Data Exchange Framework - California Health and Human Services." California Health and Human Services, 2 Nov. 2022, www.chhs.ca.gov/data-exchange-framework/.
"Data Modernization Initiative." CDC, 7 Apr. 2022, www.cdc.gov/surveillance/data-modernization/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fsurveillance%2Fsurveillance-data-strategies%2Fdata-IT-transformation.html.
"Data Use and Reciprocal Support Agreement (DURSA)." EHealth Exchange, ehealthexchange.org/dursa/. Accessed 21 Nov. 2022.
Department of Health and Human Services. "21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program." Federal Register, 1 May 2020, www.federalregister.gov/documents/2020/05/01/2020-07419/21st-century-cures-act-interoperability-information-blocking-and-the-onc-health-it-certification.
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Dixon-Luinenburg, Miranda. "Our Health Care Data Infrastructure Is Broken. Caitlin Rivers Hopes to Fix It." Vox, 20 Oct. 2022, www.vox.com/future-perfect/23391784/future-perfect-50-caitlin-rivers-epidemiologist.
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"Introduction to the Interoperability Standards Advisory (ISA)." Healthit.gov, 2019, www.healthit.gov/isa/.
"ISA Document Table of Contents." HealthIT.gov, n.d., www.healthit.gov/isa/isa-document-table-contents.
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McKinsey & Company. "Measuring preparedness: Are public health systems ready for the next pandemic?" October 27, 2022.
"Multiple Chronic Conditions." Ahrq.gov, 2021, www.ahrq.gov/patient-safety/settings/long-term-care/resource/multichronic/mcc.html.
"National Trends in Hospital and Physician Adoption of Electronic Health Records." HealthIT.gov, n.d., www.healthit.gov/data/quickstats/national-trends-hospital-and-physician-adoption-electronic-health-records#:~:text=As%20of%202019%2C%20about%20three-quarters%20of%20office-based%20physicians. Accessed 4 Nov. 2022.
"NextGen Says It Will Apply as a Qualified Health Information Network." Healthcare IT News, 17 Aug. 2022, www.healthcareitnews.com/news/nextgen-says-it-will-apply-qualified-health-information-network?mkt_tok=NDIwLVlOQS0yOTIAAAGGY_iXf4Jmf1vdP1VrVLcoellEkirx1ff13_mObDKxhagx7mwrJj5ShhdgkmqtB9q1wWQogpYpkeMwDlepesNO8Cm6vNgAV_yPe-sHwU_2. Accessed 13 Sept. 2022.
Office of the National Coordinator for Health Information Technology. 'Percent of Hospitals, By Type, that Possess Certified Health IT,' Health IT Quick-Stat #52. https://www.healthit.gov/data/quickstats/percent-hospitals-type-possess-certified-health-it. September 2018.
ONC. "About the ONC Health IT Certification Program." n.d. www.healthit.gov/topic/certification-ehrs/about-onc-health-it-certification-program.
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APPENDIX 1.0
Key Initiative Planning for Interoperability Readiness
Goals | Challenges | Solutions | Proposed Support and Tools
APPENDIX 1.0 Key Initiative Planning for Interoperability Readiness
Goals | Challenges | Solutions | Proposed Support and Tools
Data Strategy and Integration |
Data Management Strategy |
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APPENDIX 1.0 Key Initiative Planning for Interoperability Readiness
Goals | Challenges | Solutions | Proposed Support and Tools
Data and Business Intelligence | Data Market, Valuation, and DataOps | Data Architecture for Interoperability | |
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APPENDIX 1.0 Key Initiative Planning for Interoperability Readiness
Goals | Challenges | Solutions | Proposed Support and Tools
Data Governance | Data Quality | Artificial Intelligence | |
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APPENDIX 2.0
Public Policy and Government Efforts
US and Global
APPENDIX 2.0
Public Policy and Government Efforts
US and global: A list of significant initiatives
How governments are working to facilitate exchange both within the US and in countries around the world.
United States Policies and Initiatives
- 21st Century Cures Act (2016) and ONC Final Rule (2020)
- Interoperability Standards Advisory (ISA)
- ONC Health IT Certification Program
- Data: Elemental to Health
- National Health IT Priorities for Research
- Precision Medicine Initiative
- Patient-Centered Outcomes Research (PCOR)
- Accelerating Application Programming Interfaces (APIs) for Scientific Discovery
- Health Information Technology Workflow Automation Policy Development
- Advancing Health Data and Metadata Standards
- Leading Edge Acceleration Projects (LEAP) in Health Information Technology (Health IT)
Global Government Policies and Initiatives
At the international level, there are a variety of initiatives being led by health ministries and governments to further country-level and cross-border interoperability efforts.
- Global Digital Health Partnership
- European EHR Exchange Format
- General Data Protection Regulation (GDPR)
- e-Health Digital Service Infrastructure (eHDSI)
- European Reference Networks (ERNs)
- European Health Data Space (EHDS)
- European Interoperability Framework (EIF)
- National Digital Health Strategy and Framework for Action
- NHS England: NHS Standard Contract
- New Zealand: Interoperability Roadmap
For illustrative purposes. Significant US and Global initiatives. Not an exhaustive list.
"Achieving interoperability to date has required government involvement, guidance, and regulation. Public policy efforts have the potential to drive forward frameworks for trusted exchange, align and educate stakeholders on existing and emerging standards, and broaden stakeholder participation to ensure an inclusive exchange ecosystem for care coordination and continuity."
HIMSS, 2020
APPENDIX 2.0
US Policies and Government Effort
Goal: Achieving Interoperable Nationwide Exchange
The U.S. Department of Health and Human Services (HHS) has enacted and implemented a variety of legislation, regulations, and guidance to further the adoption of standards-based approaches to interoperability.
Among the health IT provisions outlined in the 21st Century Cures Act, many sections provide directives to the ONC, Centers for Medicare and Medicaid Services (CMS), and other agencies related to improving interoperability including the Trusted Exchange Framework and Common Agreement (TEFCA) and the US Core Data for Interoperability (USCDI), among others. |
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Supports seamless and secure access, exchange, and use of electronic health information and calls on the healthcare industry to adopt standardized application programming interfaces (APIs). |
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Provides the industry with a single, public list of standards and implementation specifications that can be used to address specific health information interoperability needs in the United States including interoperability for clinical, public health, and research purposes. |
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A voluntary certification program established by the ONC that provides for health IT certification through standards adoption, implementation specifications, and certification criteria. |
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A multi-year campaign to build a 21st-century public health information superhighway that aims to drive federal investment over the next decade through the US CDC in order to transform today's public health data systems into a state-of-the-art, secure, and fully interoperable system. |
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A policy and development agenda, which articulates a vision of a health IT infrastructure that supports alignment between the clinical and research ecosystems. |
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A nationwide initiative to move away from the "one-size-fits-all" approach to health care delivery and tailor treatment and prevention strategies to people's unique characteristics, including environment, lifestyle, and biology. |
Ten projects that inform policy, standards, and services specific to the adoption and implementation of a patient-centered outcomes research (PCOR) data infrastructure. |
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Accelerating Application Programming Interfaces (APIs) for Scientific Discovery |
An initiative to develop standardized methods, through open APIs, to enhance communication and interaction between different health IT systems and mobile applications, which will help reduce the effort it takes to access, exchange, and use electronic health information. |
Health Information Technology Workflow Automation Policy Development |
An ONC-led project to explore how automation may support healthcare workflows using modern computing including perspectives from healthcare and from other industries, such as finance, hospitality, and manufacturing. |
A project to advance high-priority health data and metadata standards that support findable, accessible, interoperable, and reusable (FAIR) principles that can be implemented or required by federal agencies or other relevant stakeholders. |
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Leading Edge Acceleration Projects (LEAP) in Health Information Technology (Health IT) |
Addresses fast-emerging challenges that inhibit the development, use, and advancement of interoperable health IT. |
For illustrative purposes. Significant US initiatives. Not an exhaustive list.
APPENDIX 2.0
Global Policies and Government Effort
An annotated list of significant global interoperability initiatives
Goal: Facilitate country-level and cross-border interoperability.
At the international level, there are a variety of initiatives being led by health ministries and governments to further country-level and cross-border interoperability efforts.
A collaboration of over 40 governments and territories, government agencies, and the World Health Organization formed to support the effective implementation of digital health services. Interoperability is one of the various work streams explored by GDHP. |
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A framework that will enable citizens to securely access and exchange their health data across borders wherever they are in the EU. |
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Provides the legal framework for the protection of personal data set forth in the European EHR Exchange format. |
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An infrastructure ensuring the continuity of care for European citizens while they are traveling abroad in the EU giving EU countries the possibility to exchange health data in a secure, efficient, and interoperable way with an initial focus on enabling the exchange of baseline health information, including ePatient Summary, ePrescription, and eDispensation. |
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Networks that enable virtual panels of EU clinicians to diagnose and treat patients suffering from rare, complex, and low-prevalence diseases. |
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A priority of the European Commission's 2019-2024 EU Digital Strategy to foster the exchange and sharing of different kinds of health data (electronic health records, genomics, registries, etc.) aiming to support the exchange for the delivery of primary care and development of new treatments, medicines, medical devices, and services. |
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Specific guidance on how to set up interoperable digital public services offering public administrations recommendations on how to improve governance of their interoperability activities, establish cross-organizational relationships, and streamline processes supporting end-to-end digital services. |
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Australia: National Digital Health Strategy Framework for Action |
Establishes the foundation for a sustainable Australian health system and coordinates work between governments, healthcare providers, consumers, innovators, and the technology industry. The framework promotes collaboration and information sharing facilitating standards for interoperability, regulations, and policies to support digital health solutions. |
Requires organizations to align their inpatient, emergency care, mental health discharges and outpatient letters to nationally published specifications. |
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Accelerates the shift to a fully interoperable digital health system ensuring that health information can be accessed by consumers, health professionals, and individuals anywhere, anytime, and anyhow. |
For illustrative purposes only. Significant Global initiatives. Not an exhaustive list.
APPENDIX 3.0
Health and Health-Related Stakeholders and Data Sources
An alphabetical listing of stakeholders and data sources by industry or stakeholder category.
APPENDIX 3.0
Health and Health-Related Stakeholders and Data Sources
An alphabetical listing of stakeholders and data sources by industry or stakeholder category
Healthcare |
Government |
Organizations and Coalitions |
Business and Industry |
Community Services |
Complimentary Service Providers |
Education |
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APPENDIX 4.0
US Exchange Initiatives
An environmental scan of us exchange initiatives: who they are and what they do.
APPENDIX 4.0
US Exchange Initiatives
US exchange initiatives come in many shapes and sizes. Some are non-profit organizations. Others are private or public/private collaborations. Some are nationwide in scope and others are global. Regardless of their operating framework and scope, many organizations are actively working to achieve ubiquitous exchange.
Environmental Scan of Exchange Initiatives
This environmental scan summary provides an annotated review of the current landscape of the US-based networks and frameworks which enable interoperable, nationwide and global health information exchange via a variety of methods and collaborations.
Click here to access HIMSS' fully curated review of the current US-based landscape
Care Everywhere (Epic) | A private provider-centric global HIE platform that is primarily a federated model whose mission is to create a more comprehensive health record and improve the speed of care. |
Carequality | A nationwide network-to-network non-profit, public-private collaborative. It is independently governed, but supported by The Sequoia Project providing a trust framework that can be leveraged by existing networks and service providers to enable the sharing of data across these networks, services, and their participants. |
CARIN Alliance | A nationwide consumer directed public/private partnership network allowing for the consumer or their authorized caregiver to electronically request access to their health information from a third-party application of their choice to any provider or hospital of their choice, and for a covered entity to electronically send that data to the consumer. |
DirectTrust | A nationwide non-profit trade association (501c6) and secure messaging network that supports trusted use of direct messaging within the DirectTrust Network. The Framework scales trust by making it unnecessary to negotiate one-off agreements, instead creating a "network of trust." |
eHealth Exchange | A nationwide provider-centric non-profit and public-private collaborative network governed by a Data Use and Reciprocal Support Agreement (DURSA). The Sequoia Project assumed support in 2012. Although it does not provide the technology for exchange, eHealth Exchange outlines the specifications for exchange and, most popularly, connects private sector providers/HIEs to federal agencies. |
National Association for Trusted Exchange (NATE) | A nationwide not-for-profit person-centric network association of organizations, governed by a board of directors focused on facilitating consumer/patient access to information and enabling trusted exchange among organizations and individuals with differing regulatory environments and exchange preferences. |
Patient Centered Data Home (PCDH) | A regional/nationwide patient-centric network governed by a PCDH governing council that enables the exchange of patient information across "home HIE" organizations and non-home HIE organizations. |
Surescripts | Privately owned by the National Association of Chain Drug Stores (NACDS), National Community Pharmacists Association (NCPA), CVS Health and Express Scripts. Surescripts is a nationwide record locator service and query-based exchange that allows healthcare professionals to share prescription and clinical information to manage the care of patients. |
CommonWell Health Alliance | A nationwide network to network not-for-profit trade association funded by members that enables exchange across vendors through the implementation of its services with participating vendors including patient enrollment, record location, patient identification and linking, and data query/retrieval. |
APPENDIX 5.0
International Networks Enabling Exchange
Digital health continues to expand at a rapid pace toward strengthening health and healthcare systems worldwide.
APPENDIX 5.0
International Networks Enabling Exchange
International digital health leaders from 33 nations and territories and three international organizations that represent over 2.8 billion people. Efforts are focused on working to provide opportunities for worldwide participants to exchange best practices for data sharing, electronic health records exchange, patient access, among other important opportunities.
International Networks
Digital health continues to expand at a rapid pace toward strengthening health and healthcare systems worldwide. Interoperability is a major focus area in:
- Overcoming patient data sharing challenges between health care providers, health organizations, caregivers, and patients.
- Determining the path forward for addressing interoperability challenges through standards and technology.
Geographic Region/Country |
Exchange Initiative |
Description |
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European Union (EU) |
EHDSI facilitates the two primary building blocks of cross-border digital health services in Europe: ePrescription and Patient Summary. ePrescription (and eDispensation) allows EU citizens to obtain their medication in a pharmacy located in another EU country. Patient Summary provides information on important health related aspects such as allergies, current medication, previous illness, surgeries, etc. The digital Patient Summary is meant to provide doctors with essential information in their own language concerning the patient, when the patient comes from another EU country and there may be a linguistic barrier. |
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Virtual networks involving healthcare providers across Europe that aim to facilitate discussion on complex or rare diseases and conditions that require highly specialized treatment, and concentrated knowledge and resources. Coordinators convene virtual advisory panels of medical specialists across different disciplines, using a dedicated IT platform and telemedicine tools. |
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Australia |
A CDA-based secure online summary of a patient's key health information used to store shared health summaries, eReferrals, specialist letters, discharge summaries, event summaries, prescription and dispense records, and diagnostic imaging and pathology reports. Patients are enabled to manage access and permissions. |
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Canada |
Transmits prescriptions from prescribers to pharmacies for dispensing. |
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Establishes a national HIE specifically to accelerate citizen access to personal health information and digital health services using a cloud-based infrastructure, a FHIR® based API service, and a blockchain enabled consent service. |
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United Kingdom |
Includes the delivery of national capabilities and national standards. |
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Enables the delivery of interoperable care records and improved local planning. |
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Global |
The Global Digital Health Partnership (GDHP) is a collaboration of country governments, territory governments, and international organizations formed to support the executive implementation of worldwide digital health services. Interoperability is a critical workstream and focus. |
For illustrative purposes only. Significant international exchange initiatives. Not an exhaustive list.
Source: GDHP, "Connected Health: Empowering Health Through Interoperability," 2019
Click here to access the Global Digital Health Partnership's white paper on interoperability and key findings