Interoperability is one of those terms that everybody thinks they understand.  When you press people for a definition you usually get a shuffling of the feet and a blank look.  “Well,  it’s when things talk to each other, right?”

This isn’t actually an unreasonable response because there are at least four competing definitions for the term in the modern healthcare arena and they are all subtly related.   Today we’re going to take a look at definitions from IEEE, HIMSS, HL7  and ONC.  As  you’ll see, the water is somewhat murky.

Our discussion starts with the IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries (New York, NY: 1990) where interoperability is defined as;

The ability of two or more systems or components to exchange information and to use the information that has been exchanged. See IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries (New York, NY: 1990).

The key here is that both exchange of information and the use of that information are required. It’s not enough to send another system a dump and have them store it. Somebody actually needs to do something with it, though the definition provides very little guidance as to what that might be.

HL7’s definition of interoperability starts with the IEEE definition, then adds a couple of subtypes  of interoperability that further distinguish between exchange and use.

  • “Functional” interoperability is the capability to reliably exchange information without error
  • “Semantic” interoperability is the ability to interpret, and, therefore, to make effective use of the information so exchanged.

You will note the term ‘ effective use’  which means that the information can be used in any type of computable algorithm (appropriate) to that information.

The HIMSS  definition builds further on  the concepts within the HL7  definition.

Interoperability means the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.3 There are three levels of health information technology interoperability: 4 1) Foundational; 2) Structural; and 3) Semantic.

Ok.  What do these terms mean?  Thankfully HIMSS did a great job of defining them.

  • “Foundational” interoperability allows data exchange from one information technology system to be received by another and does not require the ability for the receiving information technology system to interpret the data.
  • “Structural” interoperability is an intermediate level that defines the structure or format of data exchange (i.e., the message format standards) where there is uniform movement of healthcare data from one system to another such that the clinical or operational purpose and meaning of the data is preserved and unaltered. Structural interoperability defines the syntax of the data exchange. It ensures that data exchanges between information technology systems can be interpreted at the data field level.
  • “Semantic” interoperability provides interoperability at the highest level, which is the ability of two or more systems or elements to exchange information and to use the information that has been exchanged.5 Semantic interoperability takes advantage of both the structuring of the data exchange and the codification of the data including vocabulary so that the receiving information technology systems can interpret the data. This level of interoperability supports the electronic exchange of patient summary information among caregivers and other authorized parties via potentially disparate electronic health record (EHR) systems and other systems to improve quality, safety, efficiency, and efficacy of healthcare delivery.6

I would posit structural interoperability is a refinement of functional interoperability as defined by HL7.   The semantic definition is considerably more specific.

The last definition we will consider is from ONC.

All individuals, their families, and their health care providers have appropriate access to health information that facilitates informed decision-making, supports coordinated health management, allows patients to be active partners in their health and care, and improves the overall health of our population.

Boy, that’s a mouthful.   This is perhaps the broadest definition with the least detail and is really a policy statement.  There’s very little detail to be found here.

Now that you know the four definitions of interoperability you should be able to play “stump the chump” with anybody you come across at the show!  I hope this proves useful!

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