1. Interoperability Fred Church – Sales and Upgrades Manager
Jeff Marr – Sales & Marketing Manager
Gary Weiner - Vice President of Global Healthcare IT Solutions

2. What is Interoperability
In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.
Data exchange schema and standards should permit data to be shared across clinicians, lab, hospital, pharmacy, and patient regardless of the application or application vendor.
Interoperability means the ability of health information systems to work together within and across organizational boundaries in order to advance the health status of, and the effective delivery of healthcare for, individuals and communities.
Source HIMSS

3. Interoperability
Since the advent of healthcare information technology, the lack of interoperability and data silos have created a gap between providers, hospitals (and various hospital departments), laboratories, and payers.
In today’s complex and ever-changing healthcare environment, it is becoming increasingly vital for healthcare providers and diagnosticians to have access to the clinical information they need on which to base their next level of care, improve patient care and patient outcomes, and ensure accurate and timely billing.
Healthcare providers need to have the ability to treat patients from any point of care in the system. This improves quality and efficiency— and results in better patient outcomes. Today, with newer technologies and interoperability, gone are the days of segregated clinical information between the HIS/EMR system and the LIS.
HIS/EMR and practice management vendors are utilizing newer technologies to gather information from various systems in a more integrated fashion.

4. Levels of Technology Interoperability
Foundational
Structural
Semantic

5. “Foundational” Interoperability
“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.

6. “Structural” Interoperability
Examples
HL7
CCD/CCDA
Definition
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.

7. “Semantic” interoperability
Definition
Example
“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
Sorting Lab Data
Similarly, local medical testing facilities often use proprietary lab data, often lacking any standardization, as opposed to the industry standard LOINC codes, which are required for reporting under the federal government’s Meaningful Use program. To qualify for meaningful use incentives, a provider must be able to report, for example, Clinical Quality Measure CMS122v2, “The percentage of patients 18–75 years of age with diabetes (type 1 or type 2) who had HbA1c >9.0%” [3].  Identifying patients with diabetes is relatively easy but when “HbA1c” can be represented over 100 different ways, it is difficult to query and ensure accuracy of the measure. Automated mapping solutions can streamline the mapping process to enable semantic interoperability and make it easy to make meaningful use of the patient data.  

8. Why Semantic interoperability
HIE, ACO and PCMH organizations and models.
Evidence-based care protocols
Quality improvement programs
Population health management
Pay-for-performance programs
Data warehousing and analysis

9. SCC Interoperability with EMR’s
LIS were the first “clinical information system” dating back to the late 60’s.
Modern EMR’s have evolved from previous generation, financial oriented HIS to become a comprehensive electronic record of the patient.
There is mounting pressure from the major EMR vendors to displace Best-of-Breed systems, including LIS, within their clients
SCC continues to provide the laboratory with advantages in functionality and productivity.
SCC is committed to providing interoperability with the major LIS vendors.

10. SCC’s Interoperability
SCC is utilizing newer technologies (Web Services and Enterprise service bus) and the new FHIR standard to deliver this information to the caregiver.
As a best-of-breed LIS vendor, SCC’s products have always been ‘open’. We have an unmatched reputation for writing complex interfaces and working with our industry colleagues to ensure that our clients’ clinical environments get the data exchange they need.
SCC Soft Computer has nearly four decades of experience in healthcare information technology, and we understand that interoperability between clinical applications is critical for success – whether it’s our own robust healthcare information technology solutions, an instrument, or a module from another vendor. We begin our design/development process with three principles/standards, one of which is to build data migration and integration into our products.
With SCC’s advanced system architecture, we offer many ways to integrate with your EMR vendor. For example, you can even place an icon in the EMR that launches SoftLab® should you need to see more detail regarding the laboratory order—without leaving your EMR screen.

11. Opening up systems to share data and enhance workflows
Technologies
Examples
Web Services
Open API
URL linking
FHIR
Patient Demographics
Foreign Registration
Scheduling request
Allergy
Medication + Prescription
Observation - Vital Signs
Family Member History
Enterprise Image Access

12. Interoperability

13. EMR interoperability

14. Example
A recent example of the interoperability that exists between SCC and EMR vendors took place at a client site where the pathologist who was using SoftPath® wanted to see the patient’s previous history. The client and SCC worked together to achieve functionality where the pathologist was able to click on a single history button on the SoftPath screen to go into the EMR to retrieve and render the patient’s previous history without having to leave the screen in SoftPath and go into a separate system.

15. SCC Interoperability Study
We are seeking other ideas or case studies where we can demonstrate features of interoperability that will help improve your healthcare delivery process. SCC Soft Computer invites you to participate in our first-ever interoperability study. We’re interested in any interoperability issues you may be having and what enhancements of SCC’s systems and/or your current EMR system would be beneficial. If your facility chooses to participate, you will have 90 days to submit your responses to SCC via an online form. SCC will compile and evaluate the data received to determine the global issues, and we will publish a white paper where we present our findings from the study—and our mitigation plan. (Client-specific issues will be addressed separately via support tasks.)
To participate, please visit SCC’s Client Support site. After you have logged in, click the link to take a brief interoperability survey. SCC will evaluate your responses and will contact you with strategies that will work with your EMR vendor. If your issues are client-specific, we will work with Technical Support to come up with a resolution to your facility’s specific interoperability challenges.
If you have any questions, comments, or concerns, please contact your SCC Client Relation Manager. We look forward to hearing from you and helping you achieve true interoperability between your SCC systems and your EMR system.

17. SCC Interoperability Introduction
On (XYZ) date SCC welcomed all SCC Users the opportunity to submit potential interoperability cases via online form located on TSS

18. Online Submission

19. Submission Form

20. Submission Form

21. View Submissions

22. Review
Upon submission, an is automatically generating notifying the designated SCC Technical representative to provide initial review.
Submission Criteria
Does this meet the Interoperability criteria?
If no, Is this client specific setup?
If no, Is the functionality currently in the system?
Upon review, if 2 and 3 are determined to be yes, SCC will notify client and work to provide solution
If #1 is yes, then submission passes to 2nd round of review by SCC R&D

23. Findings 44 Total Submissions
17 of 44 total submissions identified to quality for interoperability
Balance identified to be client specific setup or functionality exists or not connected to Interoperability

24. Preliminary Technical Findings
Meaningful Use
Upgrade of HIS and Ref-Lab interfaces and ELR to HL
HIS interfaces
Standardization is increased
Requires Discrete Micro Resulting
Ref-Lab interfaces – Quest & LabCorp
SCC pushed these vendors in their development and deployment of these interfaces
Required Discrete Micro results
Micro results posted directly into SoftMic
Improved workflow in SoftMic
Improved usability of results in EMR   
ELR – Electronic reporting to State
 Reduces manual processes
Improves accuracy

25. Preliminary Technical Findings
Image and Document Management
SoftMedia role
Enterprise Systems like OnBase
PDF’s and hyperlinks
Ref-lab interfaces
Hospital and Dr. office EMR’s

26. Preliminary Technical Findings
Transfusion Administration Systems             
SoftTx  
In later BB releases – Enhanced resulting capabilities
Possible – import of automated vitals
Universal Log-in Authentication
Document Transfusion rate
Auto addition of new user
 Document Blood warmer usage
BPAM – EPIC
In later BB releases – Enhanced SoftBank resulting capabilities
Transfusion status update
When transfusion status changes in EPIC Blood Product Administration Module SCC LIS (SoftBank could receive status updates)

27. Preliminary Technical Findings
Specimen Label Management from EMR
SCC has several EPIC 4.5 clients who manage patient labels thru a mixture of Nurse-EMR and SoftID – Lab collect  
SCC sends labels to EMR-EPIC
EPIC-EMR initiate label release – Nurse Worksheet release
SCC has a current 4.08 client working toward similar approach
Comments Mapping
EMR order comments
SCC Call comments
There are not standardized HL7 specific functions – requires creative mapping

28. Next Steps
SCC is reviewing the qualified submissions to determine: Level of Impact Technical Requirements Proposed Solution Timeframe for Proposed Solution Q2 2018

29. Future Studies
Introduce 2018/2019 Study beginning of Q3 Re-Open submission form beginning of Q3 Close submission form beginning of Q4 Review submission Q / Q Report on 2018/2019 at Annual SNUG Conference