Interoperability in the Health Ecosystem
Interoperability is 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. Health data exchange architectures, application interfaces and standards enable data to be accessed and shared appropriately and securely across the complete spectrum of care, within all applicable settings and with relevant stakeholders, including by the individual.
Four Levels of Interoperability:
Foundational (Level 1) – establishes the inter-connectivity requirements needed for one system or application to securely communicate data to and receive data from another
Structural (Level 2) – defines the format, syntax, and organization of data exchange including at the data field level for interpretation
Semantic (Level 3) – provides for common underlying models and codification of the data including the use of data elements with standardized definitions from publicly available value sets and coding vocabularies, providing shared understanding and meaning to the user
“New” Organizational (Level 4) – 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
1 HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations, 4th Edition, 2017.
2 American Academy of Family Physicians (AAFP), Center for Health IT, 2013.
3 National Committee on Vital and Health Statistics (NCVHS) Report on Uniform Data Standards for Patient Medical Record Information, July 6, 2000, pp. 21-22.
4 Institute of Electrical and Electronics Engineers, IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries, New York, NY: 1990.
5 National Academy of Medicine (NAM), Procuring Interoperability: Achieving High-Quality, Connected and Person-Centered Care, Washington, DC: 2018.
6 Health Level 7 (HL7) Interoperability Project Team, Interoperability Definition: 2007.
7 Office of the National Coordinator for Health Information Technology, 21st Century Cures Act Interoperability Definition: 2016.
8 European Commission, New European Interoperability Framework: 2017.