Interoperability in Healthcare: What You Need to Know (And How to Get There with RPA)

Picture a standard medical procedure. You visit your primary care physician for the initial diagnosis. They prescribe a medication or refer you to another specialist. Some cases may require lab tests, long-term treatment, or hospitalization. All key details are saved in your patient history once the treatment is complete, covered, and paid for.

Behind the scenes, this rudimentary procedure involves moving heaps of medical records between healthcare providers, facilities, labs, pharmacies, and insurers. Typically, all of them use their internal systems to store patient data, so for all this process to function with minimum error and delays, healthcare organizations need one crucial ingredient: interoperability.

But what is interoperability in healthcare, really? What software systems are involved, which regulations and standards apply, and—crucial from the RPA perspective—how can automation support healthcare organizations in connecting seamlessly? Let’s find out.

In healthcare, interoperability means the ability of multiple software systems (such as Electronic Health Record software—EHR, Hospital Management Systems, Medical Billing Software, etc.) to exchange and use medical data. An interoperable medical records network allows all entities involved in the patient’s journey to retrieve and view consistent medical records at multiple locations simultaneously.

As a result, providers can easily go through historical patient data to better understand each case and achieve the most optimal outcomes based on data. And patients don’t need to worry about forwarding or carrying around their documentation, insurance coverage, or lab results, regardless of where or which provider they need to consult. Seems excellent, right?

The Healthcare Information and Management Systems Society (HIMSS) distinguishes four healthcare interoperability levels that describe how interconnected a system is.

One thing to note here is that true interoperability in EHR and other healthcare systems involves the transfer, interpretation, use, and governance of medical data. The transmitted data must be standardized to allow it so that all systems can understand it.

However, connecting dozens of disparate EHR systems can be a challenge. This is largely due to differences in terminology used by different providers, EHR functions, or technical specifications, and disparate data structure, which may lead to duplicate or faulty records, missing information, and, as a result, substandard and delayed services.

Another important hurdle comes from cultural differences. Some healthcare providers may share incomplete records and use siloed or fragmented data. In the most extreme cases, providers may deliberately block or limit the flow of patient records to increase their revenue and market position.

To make matters even more complicated, there’s the sheer variety of data. Patient history, personal data, treatment plans, doctor’s notes, test results, prescriptions, imaging, and diagnostic reports must all be kept in formats that enable easy sharing and access for all involved parties, from physicians to insurers.

Healthcare delivery is a team effort where all involved entities work toward a positive patient outcome. This is only possible if all roles can communicate and exchange information efficiently, meaning that interoperability in healthcare is paramount to their success.

Through the past decade, providers have made significant progress in transitioning from physical data storage to easier-to-share EHRs and other systems. As of 2021, 78% of office-based physicians in the USA and nearly all non-federal acute care hospitals (96%) adopted a certified EHR. Europe follows this trend, with increasing numbers of healthcare providers, hospitals, and practices deploying software systems to streamline their services.

This is a step in a good direction, as interoperability in EHR aims to ensure that all providers can exchange and use patient records. Aside from improved cooperation, it has a far-reaching positive impact on multiple aspects of healthcare operations:

• Higher productivity and revenue — EHR interoperability allows all involved entities to do more faster by improving data access. Instead of spending their time retrieving patient data, physicians can accept more patients.
• Data safety and compliance — A well-synergized and regulation-compliant data-sharing system is the best way to prevent leaks during patient data transfer.
• Lower costs — Better data operations translate into savings: fewer non-compliance fees, no-shows, and negative payment adjustments, combined with optimized patient transfers, improved analytics, and faster payments.
• Reduced physician burnout — On average, physicians spend 4.5 hours each day working with EHRs. Interoperability helps prevent physician burnout by reducing paperwork, manual data entry, and the time needed to retrieve the necessary records.
• Improved quality of care — With complete access to all medical details of each patient, physicians can diagnose the problem with better accuracy and suggest tailored, targeted treatment. On an organizational level, providers can use data to monitor care quality and identify improvement opportunities.
• Patient education — By connecting EHR systems with patient portals, physicians can communicate directly with patients to update them on test results, give recommendations, or suggest further care.

Interoperability requires synergizing a range of systems involved in healthcare. What are they?