Seven Approaches for Interoperability

“Standards are enablers. Interoperable systems are what support the business and clinical requirements in a typical eHealth agenda.”
– Dennis Giokas, Emerging Technology Group

Dr. Mike Muin asked us to choose a healthcare scenario to discuss and I chose this one:

Dr. Santos (Internal Medicine) uses an EMR called ClinicSys. He uses it for   SOAP notes, clinical abstracts, referral letters and admitting notes. He is a consultant at Reyes General Hospital (RGH). RGH has a Hospital Information System (HIS) called HospitalSys. Dr. Santos wants to send a patient for admission (with admitting orders) to RGH. Dr. Santos wants to get notice that patient has been admitted.

For my answers and slideshow presentation, here’s the link to Slideshare:



This was a scenario which I could relate to even if our hospital does not have a hospital information system in place. I chose to look at this assignment as a problem solving exercise. I tried to deconstruct the problem, seen from the perspective of a hospital administrator faced with an issue, looking for solutions.

Interoperability can be defined as “the ability of different information technology systems and software applications to communicate, to exchange data accurately, effectively, and consistently, and to use the information that has been exchanged.”

There are two parts to that definition – the exchange of data and the use of that data that has been exchanged. Interoperability issues can arise from any part of this equation. Dennis Giokas, Chief Information Officer and Head of Emerging Technologies Group said, “Data has to move between two or more systems – the exchange of information. The receiving system and users must be able to process and use the data. To “use” the data we need to ensure that it’s delivered in a way that can be easily understood by the receiving system and users so it can be applied. That’s where semantic interoperability enters the picture.”

In my previous blogs, I discussed the issues with regard to people, processes, technology and financial resources. Looking at it from another perspective, these factors can be seen in the Ishikawa Fishbone diagram for root cause analysis.  Modifying this a bit to fit the context of the discussion since Dr. Muin said there were no financial constraints, I came up with this diagram (Figure 1):


Figure 1. Ishikawa Fishbone Diagram for Interoperability Issues between 2 Disparate Information Systems


From this diagram, I came up with the following project goals:
– Evaluate cause and effect factors by reviewing Fishbone diagram
– Create an IT support group for medical staff
– Form a technical working group which includes medical staff, hospital   management, IT support group to discuss ways to integrate disparate doctors’ systems and hospital system
– Determine standards needed such as data content standard, data exchange standard
– Identify and prevent data level conflicts
– Re-train hospital staff regarding data collection and coding

From my research, approaches that can be used for interoperability issues are those represented in this diagram (Figure 2). Information in IS1 is represented by vertical lines, while the information in IS2 is shown as horizontal lines representing a disparate system.


7 Approaches.001

Figure 2. Approaches for Interoperability between Disparate Information Systems

The discussion for each approach can be seen in my Slideshare presentation or thru my citation of references.
My options for this problem are:
– Check if an upgrade for both Information Systems would resolve the problem
– Upgrade the Hospital Information System, find out which Clinic Systems are interoperable then inform doctors of these systems, have them switch
– Replace present Hospital Information System with another having a strategic intent of interoperability with other systems
– Use Database translation approach if only the ClinicSys of Dr. Santos is to be considered
– Use Standardization approach if several other doctors have their own disparate information systems
– Consider a Web-based platform information system for everyone to use

Dubbed as “the holy grail” of health IT, the issue is so complex because there are multiple levels of integration and many possible applications. HL7 and SNOMED CT seem to be the direction that we are headed to.

Barriers cited for interoperability are:
– Barrier #1: Lack of a master reference information model
– Barrier #2: Limited collection of codified clinical data
– Barrier #3: Limited use of controlled medical vocabularies
– Barrier #4: Technical challenges to providing data comparability
– Barrier #5   Lack of a messaging standard which supports semantic interoperability

Kerry Stratton, the managing director of IT system company InterSystems however said, “Some of the biggest barriers to interoperability could be human rather than technical.” We, as students of health informatics and future leaders of the industry are placed in the forefront to find solutions for health information system interoperability.

1. Interoperability of Information Systems. webpage. Accessed thru:
2. Semantic Interoperability: The Holy Grail of Medical Informatics. E-mds webpage. Accessed thru:
3. The Holy Grail of IT integration. webpage. Accessed thru: