A Multi-Tiered Perspective on Healthcare Interoperability

Introduction

The ability to deliver efficient and effective healthcare services is dependent on designing and implementing interoperable health information systems. As healthcare delivery becomes distributed across multiple providers and settings it is interoperability that will allow clinical data and processes to be accessible in these different settings. However, the notion of interoperability is multifaceted and complex. Although the exchange of data is often analogous with interoperability we need to remember that healthcare is a process oriented domain and therefore clinical, management, organizational and healthcare system processes must be considered as part of interoperability.

One of the difficulties with interoperability is that it is sometimes discussed as an abstract concept. At basic level, interoperability is the means of connecting two or more computer systems. However, those systems are used by people to conduct healthcare processes and therefore we need to take into consideration the actual processes that we are trying to make interoperable. We suggest that interoperability is not the ends but rather it is the means of supporting healthcare delivery. The 2001 study from the Institute of Medicine ‘Crossing the Quality Chasm: A New Healthcare System for the 21^st Century’ described the quality of care delivery as inadequate and that to improve care delivery would require a commitment to an agenda of efficient, effective, timely, safe, and equitable patient centered care (Institute of Medicine, 2001). Interoperability is the means for achieving those objectives and the true test of interoperability will be how well it helps us achieve them.

This chapter discusses healthcare delivery and the role interoperability plays in it. In particular we emphasize the need to consider interoperability at the process level. In the chapter we first provide a background on healthcare interoperability that looks at it from multiple perspectives. We then present a case study of collaborative care delivery and use it to outline specific interoperability requirements. We then use these requirements to develop a multi-tiered framework of healthcare interoperability. We conclude with a discussion of the implications of the chapter for future interoperability research and for systems design to support healthcare delivery.