As patients demand greater access to their health data, and healthcare professionals require seamless integration of information to provide high-quality care, the need for healthcare organizations to share information only intensifies.

An Angus Reid survey of 150 digital health professionals was recently commissioned by Orion Health and shared with Canadian Healthcare Technology readers, taking the collective pulse on the state of healthcare interoperability in this country.

Proof that interoperability works: When asked about the biggest benefits organizations have seen from interoperability, six-in-10 (59%) respondents said effective care, and about half (52%) said they have seen improvements to patient safety. Improved accuracy of medication information came in next, followed by cost savings through reduced duplication of lab and radiology tests and prescriptions.

When asked which of the following data types were being exchanged electronically, two-thirds of respondents (66%) answered laboratory results, which was virtually tied with patient demographics (64%). Next up were clinical documents (such as referrals, discharges, clinical assessments), radiology reports and medication data (such as opioids and other controlled substances). Overall, nearly six-in-10 organizations exchange data with a provincial Electronic Health Record.

Additionally, six-in-10 respondents said their future plans for interoperability include e-referrals, along with clinical documents (such as discharges, clinical assessments, etc.). After that, the top responses were patient-generated data, medication data, behavioural health data and finally, non-traditional data such as genomics or social determinants.

Breaking down the barriers: There are a number of barriers limiting the electronic exchange of health information, including financial barriers (cost of development, payment models for physicians and an inability to access budgets); technical barriers (poor end-user experience, lack of agreement on standards and poor data quality); and trust or legal barriers (privacy issues and data blocking). All of these inhibit adoption of interoperability.

What is driving healthcare innovation investment? The top drivers for investment in interoperability rank as follows: care coordination, provincial government mandates, clinician demand, patient benefits, a desire to connect community care with primary and acute care and finally, patient safety.

The technical levels of interoperability: When asked to describe the state of interoperability at their healthcare organization, seven-in-10 responded it was foundational (a level that allows data exchange from one IT system to another but does not require the ability to interpret data).

Half responded they have achieved structural interoperability (ensuring data between IT systems can be interpreted at the data field level). Finally, three-in-10 answered they had achieved semantic interoperability (the highest level, enabling systems to exchange and use information in downstream clinical care processes).

Interoperability standards help stakeholders exchange electronic health information, impacting the quality and cost of care, and ultimately outcomes. There is growing support for application programming interface (API) based standards such as Fast Healthcare Interoperability Resources (FHIR), developed by Health Level Seven International (HL7).
Here are primary standards ranked by use at healthcare organizations: HL7 v2 is being used by nearly half of respondents (46%), followed by FHIR (31%), HL7 v3 (28%) and finally Consolidated CDA (CCDA) at 19 percent.

How the government can help: Nine-in- 10 respondents feel that additional government support would improve interoperability in their jurisdiction. Legislation to improve interoperability ranked first, followed closely by government mandate to use specific standards and architectures, government support for population-based funding or Integrated Care Teams with value-based care objectives, and finally, well-publicized government support for a uniform technical approach across Canada.