Making Interoperability Possible with Better Provider Data Management

Medical advice works best with context. That’s why healthcare relies heavily on data, so doctors are better positioned to make informed diagnoses and prescriptions.

However, when you’re visiting a new doctor for the first time, context is often missing. The doctor will ask you about your medical history, allergies, and medications to better understand you. But that’s an unreliable way to go about it. Instead of relying on your memory, clinicians should be able to instantly access your complete health records – doctor visits, lab results, and prescriptions – in one place.

When record keeping was mostly manual, it was extremely challenging to curate a well-connected healthcare system that effectively coordinates data among all parties involved. However, owing to technological advancements, we now generate a massive amount of healthcare data electronically. Many doctors worldwide, including a significant portion in the United States (over 70% as of late 2021), report feeling overwhelmed by the sheer amount of patient data available to them.

Digital records are created every time you see a doctor, get a test, or fill a prescription. But the system that exists is still far from perfect. This data often gets trapped in silos, with systems unable to talk to each other. This fragmented information flow makes it difficult for doctors to understand your health situation, leading to delays, inefficiencies, and potential safety risks.

To reduce that, we’ll explore the concept of interoperability in healthcare and figure out how better provider data management could make our existing healthcare systems more efficient and reliable. 

What Is Healthcare Interoperability?

What if there was a way to share your health information easily and securely, regardless of where you received care? That’s exactly what interoperability in healthcare refers to. 

In simpler words, interoperability means different healthcare systems can talk to each other.Your doctor can access your electronic health records, even if created at a different hospital or clinic. This timely and secure access allows them to integrate and use this information effectively. Once this information is readily, speedily, and accurately available, doctors can examine your health conditions holistically and make better decisions and medical recommendations.

Health data interoperability works on standardized formats and secure exchange mechanisms:

• Standardized formats. Standardized formats ensure that your data is organized in a consistent way, making it understandable for different systems. This means that every record is filed and labeled similarly, no matter where it originates from. 
• Secure exchange mechanisms. Secure exchange mechanisms, like encryption, keep your information safe during transfer.

Benefits of Healthcare Data Integration

No more scrambling records to recall past appointments or medications. Having healthcare data integration and interconnectedness can bring both healthcare organizations and patients a wide range of benefits, including:

• Improved Care Coordination. Healthcare data integration leads to improved care coordination. With a complete picture of the patient’s health history, doctors can avoid unnecessary tests, prescribe medications more effectively, and ensure all the concerned providers are on the same page. This smooth communication lessens the chance of errors and delays, eventually making better healthcare possible for patients. 
• Improved Data Analysis. Healthcare data integration allows for enhanced and improved data analysis. Researchers can identify trends and generate more productive treatment strategies by investigating enormous amounts of health information. This results in better overall healthcare quality and potentially lower costs in the long run.
• Streamlined Provider Workflow. Filling out paperwork can be frustrating and exhaustive. Your resources are engaged in time-consuming administrative tasks that have little impact on overall healthcare quality and patient care. Thus, healthcare data integration can play a crucial role in streaming workflows for healthcare providers. With easy access to your records, providers spend less time on administrative tasks and more time focusing on your health, which is what really matters.
• Improving Public Health Efforts. Healthcare data integration also helps with enhancing public health efforts. Healthcare organizations can track disease outbreaks more effectively by transmitting anonymized data safely and devising targeted prevention strategies. This benefits everyone in the community by contributing to overall better health for all.

Impact of APIs on Healthcare Data Exchange

To understand this better, we’ll use an example.

Consider a mobile phone that contains several apps reserved for specific functionalities. Now, some of these applications work together to provide you with a smooth and integrated mobile experience.

Let’s say we’re looking at the YouTube application, which syncs with your Google account’s history to provide recommendations that align with your search habits and history. This is only possible if information is exchanged between these applications.

The healthcare industry works similarly. Different systems need to share data seamlessly, and they do this through APIs. APIs, or Application Programming Interfaces, act as messengers between computer programs. They allow them to securely exchange information in a standardized format, even if they were built by different companies.

In healthcare, APIs facilitate communication between electronic health record (EHR) systems and other healthcare applications. This means your doctor's system can easily talk to the system at the lab you visited or the pharmacy where you filled your prescription.

Here are some of the most important API standards used in healthcare:

• FHIR (Fast Healthcare Interoperability Resources). FHIR is a common language for all healthcare data. It ensures that all information exchanged through APIs is organized and understood similarly. With FHIR in place, healthcare data can flow freely and securely between different systems. This uniformity allows the healthcare industry to have an interconnected healthcare experience, where clinicians have a more comprehensive picture of the patient’s health.
• DICOM (Digital Imaging and Communications in Medicine). This standard involves exchanging medical images (X-rays, MRIs, etc.) between healthcare IT systems. DICOM ensures these images are transferred safely and consistently, regardless of the software used by the sending and receiving systems. 
• CCDA (Continuity of Care Document). This standard outlines a uniform format for summarizing a patient's medical history. A CCDA document includes information like allergies, medications, diagnoses, immunizations, and procedures. With CCDA, healthcare providers can readily exchange a comprehensive patient overview through APIs, promoting better care coordination and reducing the need for repetitious tests or information collection.

The Four Levels of Interoperability in Healthcare

It’s impossible to enable seamless data exchange among healthcare systems overnight or even within months. There’s a complete roadmap, with levels, to understand how interoperability works at different stages.

Here are the four levels of interoperability in healthcare:

1. Foundational Interoperability. Foundational interoperability looks at Healthcare data integration at a very basic level. At this stage, systems can simply exchange data safely, but they may not understand the meaning of that data.
2. Structural Interoperability. The second level, structural interoperability, focuses on the format and organization of the data. Here, systems can exchange data securely and simultaneously understand the structure—like the different sections of a document. This allows for interpretation, but it’s still very basic at this stage.
3. Semantic Interoperability. Semantic interoperability stands at the third level and takes things a step further. Systems at this level not only understand the structure of the data but also the meaning behind it. This is achieved through standardized coding systems, like SNOMED CT, for medical terms.
4. Organizational Interoperability. The final step, organizational interoperability, handles more comprehensive policy and social deliberations. At this level, healthcare organizations work together to establish standard practices and procedures for data exchange. This guarantees everyone is on the same page, not just in technological terms but also regarding legal and ethical considerations encompassing data privacy and security.

Challenges of Interoperability in Healthcare

Interoperability in healthcare offers useful benefits that every healthcare provider and patient can enjoy. However, achieving it isn’t a straightforward process. Many challenges down the road could make healthcare data exchange impossible if left undressed. Here are some of the most prominent ones:

• Lack of Standardization. One major hindrance toward interoperability in healthcare is the lack of standardization. Different healthcare providers often use different electronic health record (EHR) systems that don’t speak the same language. Data might be formatted differently, making it problematic for these systems to comprehend and exchange information with each other.
• Security Risks. Data security is immensely important in healthcare. Exchanging sensitive health data requires powerful security controls to safeguard privacy. Healthcare providers must be confident that their systems can exchange information without hiccups and compromises.
• Technological Needs. Healthcare organizations differ significantly in size and resources. Executing and sustaining interoperability solutions can be pricey, especially for smaller practices. This creates a situation where some providers may lag in sourcing the required technology.

Why Clean Data Matters for Seamless Healthcare

Now that we’ve examined the challenges associated with creating an interconnected healthcare information system, we’re missing one crucial requirement.

Clean, accurate, and standardized data.

Without clean data, there’s no point in creating information exchange systems. That’s why we see provider credentialing break down as a result of data silos, among other potential pitfalls.

Just like a messy room makes finding things hard, poor data management creates problems for information sharing. If the health information a doctor’s system gets is filled with errors or formatted differently, it will be harder to understand and use. This will create information silos, where valuable data gets trapped and can't be shared effectively—hindering successful patient care and increasing administrative legwork.

However, when healthcare providers keep their information accurate and standardized, different systems can easily understand and exchange information. Thus, communication becomes seamless, and the data is more accurate and reliable. Whether it be blood pressure readings, medications, or allergies—everything is recorded in a way that different systems can recognize and interpret. This removes confusion and inconsistencies in the data. Moreover, clean and standardized data is the foundation for different levels of health data interoperability, which we covered in a previous section.

Accurate information is key to basic data exchange and ensuring a shared understanding of the data's meaning. By prioritizing sound data management practices, healthcare providers can create a more connected system that benefits everyone.

How Certify Helps Achieve Interoperability in Healthcare

Certify provides a comprehensive suite of solutions for health data interoperability, with a strong emphasis on data accuracy, compliance, and streamlined processes.

Here’s how we do what we do best:

• API First Approach. Certify uses an API-first approach, meaning its system is designed to connect seamlessly with other healthcare platforms through APIs. This allows real-time data exchange and ensures authorized personnel have access to relevant information across different systems.
• Credentialing, Licensing, and Enrollment. Certify facilitates the entry of new providers into your network with its frictionless credentialing, licensing, and enrollment services. Our real-time, automated credentialing ensures NCQA compliance for payers, health systems, and digital health companies. 
• Data Accuracy and Compliance. With its multi-pronged approach, Certify keeps your provider data squeaky clean and compliant. We utilize hundreds of data sources to enrich and normalize provider information while automated monitoring ensures ongoing compliance within your network.

Ending Note

Interoperability can make healthcare more speedy, accurate, and interconnected, helping both the providers and patients. With seamless data exchange between different systems, clinicians can provide more coordinated care, researchers can develop better treatments, and public health efforts become more effective.

At Certify, we believe that everyone deserves a connected healthcare experience. Our focus on data accuracy and compliance, combined with our API-driven approach, empowers you to take control of your health information and ensure that it flows freely within the system.

Reach out to sales@certifyos.com to chat with a team member or request a demo to see how Certify can help you unlock the full potential of a connected healthcare system.