1. Health Information Exchange Interoperability
Minnesota Department of Health
December 2008
The information contained in this presentation is based on proposed and working documents.

2. Proposed Working Definition of Interoperability in Minnesota
1. Background
Variety of definitions for electronic health record (EHR) interoperability used nationally
Proposed Minnesota definition draws from this work
Minnesota definition adapted in part from:
HL7 white paper “Coming to Terms: Scoping Interoperability for Health Care” (HL7–2007)
e-Health Initiative definition (ehealthinitiative.org, 2004)
Supports statewide mandate that all health care providers adopt interoperable EHRs by 2015
Focuses on electronic exchange; health information exchange can be electronic or non-electronic

3. Proposed Working Definition of Interoperability in Minnesota (continued)
2. Principles
Includes key conceptual components of HL7 white paper and national e-Health Initiative definition
Sufficient specificity to be useful
Sufficiently dynamic to allow for necessary updating
Logical and understandable in context of Minnesota e-health environment
Supports Minnesota needs related to 2015 mandate

4. Proposed Working Definition of Interoperability in Minnesota (continued)
Interoperability of Electronic Health Records (EHR) in Minnesota means the ability of two or more EHR systems or components of EHR systems* to exchange information electronically, securely, accurately and verifiably, when and where needed; comprised of “technical”, “semantic” and “process” interoperability; the information includes transactions and standards as defined by the Commissioner of Health and currently includes the following transactions indicated below:
Electronic Prescribing / Medication Management
Immunization Information Exchange
Laboratory Results Reporting
Anticipated transactions for include:
Exchange of clinical summaries
Public Health Surveillance and Case Reporting
* Electronic health record systems includes ancillary health information systems such as laboratory, pharmacy and radiology as identified in Appendix B of statewide implementation plan.
Adapted in part from: HL7 white paper “Coming to Terms: Scoping Interoperability for Health Care” (HL7–2007), e-Health Initiative definition (ehealthinitiative.org, 2004)

5. Types of Interoperability
Technical interoperability
Neutralizes effects of distance
E.g., hardware, software, networks
Semantic interoperability
Communicates meaning
E.g., data content terminologies (e.g., ICD-10, SNOMED, LOINC)
Process interoperability
Coordinates work processes
E.g., work flow, user roles
All 3 required for consistent and timely exchange of health information among partners
Adapted in part from: HL7 white paper “Coming to Terms: Scoping Interoperability for Health Care” (HL7–2007)

6. Visual Depiction of Types of Interoperability
Technical interoperability: hardware, software, networks
Semantic interoperability:
Data content terminologies
Process interoperability:
People interacting with systems, workflow, user roles etc.,
Process interoperability:
People interacting with systems, workflow, user roles etc.,

7. Examples: Interoperability in Context of Electronic Prescribing
Technical interoperability
Appropriate hardware, software, and networks for routing prescriptions electronically
Pharmacy information system that can integrate an electronic prescription without data re-entry
Certification of electronic prescribing systems
Certification of prescriber systems (EHRs) offered by CCHIT; certification of hand held e-Rx systems to be offered in near future by CCHIT
Certification of networks offered by SureScripts-RxHub
Semantic interoperability
Usage of appropriate drug database
Ability of pharmacy application to read and interpret correctly the prescription sent by the electronic prescribing application (use of common terminology and vocabulary)
Process interoperability
User interface guidelines
Similar work/process flows in various electronic prescribing application
Options and drop-downs should be similar
Electronic prescribing process guidelines
Guidelines on when a pharmacy application detects an error in prescription
Guidelines on when a pharmacy application rejects an electronic prescription
DRAFT

8. Failure of Interoperability Examples
Three examples relating to an imaginary school bus accident:
Technical interoperability failure
Emergency Department (ED) physician receives an electronic message from the primary care physician of a critically injured student stating that student has no allergies to drugs. However, an electronic bit was inadvertently flipped during transmission; the patient dies from an allergic reaction to the drug
Semantic interoperability failure:
ED physician sends an electronic message to an overseas physician asking whether there were any warnings about a visiting student’s health. The foreign doctor sends the message code "N/A" that asserts that the information regarding allergies was never gathered. ED physician interprets the response as "Negative for Allergies" and gives an antibiotic drug; the patient dies from an allergic reaction to the drug
Process interoperability failure:
Injured school children arrive at an ED. The provider uses several different EHRs and assumes that all the systems provide alerts for allergy. This particular ED system does not have alerts implemented and thus the provider is not aware of this different process. A drug is prescribed with potential allergic reaction to an injured child.
Adapted in part from: HL7 white paper “Coming to Terms: Scoping Interoperability for Health Care” (HL7–2007)

9. Proposed Minnesota Roadmap for Standards and Interoperability