CBORD Explains: Interoperability

Interoperability is a major buzzword in healthcare today, with a Google search resulting in over 13 million hits. Interoperability is all about the technology happening behind the scenes to connect patients and their multiple care providers into a community care network and "learning health system." It is key to what is transforming healthcare right now. It's also a big part of what's driving the evolution of healthcare technologies in the U.S. and globally. The Admission, Discharge, Transfer (ADT) and Orders interfaces that use Health Level Seven International (HL7) standards to send/receive information about a patient from the hospital electronic health record to your CBORD system is an example of data exchange, but the goal of true interoperability is bigger than that.

What is it?

If you step back and look at interoperability at its highest level, it's about sharing data. In healthcare, it's really about getting your patient data to follow you wherever you are so that health professionals can access that data and provide better care.

Let's say you're a member of a health system in Upstate New York and you have to go to an emergency room in California. The concept of interoperability is the ability to exchange your data so east or west coast medical staff can pull up your record and find all they need to know about your allergies, diet, and current medications.

Another key example is being able to share your care and treatment plan with a broader healthcare team—primary care physician, specialists, dietitian, and physical therapists who are all using different electronic systems in their practices.

A Simple Comparison

I like to explain interoperability in terms of something that people understand from a different industry. Other industries, like finance or banking, already interoperate. Think about your debit card and using it at an ATM machine or in a restaurant to buy lunch. The banking industry uses your debit card to access and share certain financial information so that during a transaction a vendor can find out whether you have sufficient funds to cover the purchase you're about to make. The parties exchange information and transfer that money around. That's really similar to what the healthcare industry wants to do with patient data, except healthcare data is way more complicated. Plus, there's not a single currency that every system understands.

Interoperability is all about providing a way to move healthcare data around using a language (think $ currency) that all systems can understand. That "language" is referred to as a clinical terminology which provides standardized codes that represent various medical concepts such as your diagnosis, test results, and planned treatments, and it should also include food allergy, diet and nutrition information too. Each piece of data needs to be a consistent format with a predefined structure so that it can be understood by both computers and anyone who reads it.

CBORD's Goal

CBORD is at the forefront of creating this continuity and setting standards for diet and nutrition orders. CBORD has been an organizational member of HL7 for nearly twenty years, and CBORD team members, including Integration Services Manager Karen Nocera and Software Development Manager Curt Coulter, have helped shape the current standards in use today.

We are currently participating in efforts to help develop the next generation of standards at HL7 to support more advanced exchange of diet and nutrition information. Right now, healthcare systems can use HL7 to send and receive diet orders within a hospital, but they aren't really interoperable, in part because the diets used in one location don't have the same codes or meanings as those in the hospital next door. The Academy of Nutrition and Dietetics has identified and submitted terminology codes for diets that will help us standardize across different hospitals. So when a recently discharged hospital patient requiring texture modified foods is later checked into a different long-term care facility, the new facility should immediately know (electronically) the patient requires texture modification to eat safely. There are a lot of cases like this where we need to do work as a nutrition profession to be consistent, and CBORD is supportive of that.

Eventually we will reach a point where you can be in these totally different systems for different purposes but share the underlying data and really understand the meaning of it. We want diet orders to mean the same thing to multiple organizations. That's the goal of interoperability.