As we saw in the last article, structural and operational interoperability allow healthcare systems and providers to communicate with one another, yet there were still major challenges with regard to efficiency, redundancy, security, accuracy, and speed. Even when healthcare providers are able to electronically transmit and receive data, each one still operates as its own “island”, separate from the others. The inhabitants may or may not speak the same language. Sending information to another provider might be akin to sending a messenger in a rowboat to another island. You hope for good weather and that the message gets to the right person who will understand exactly what you wanted to tell him and that nothing happens to the messenger along the way. These islands are silos of information that may exist not just between different providers but also within one provider’s system of services such as the laboratory, pharmacy and radiology or another provider’s disciplines such as nursing, nutrition, rehab, social services and medical records. Essentially, the main issue with structural and operational interoperability is that they lack the ability of the receiver to automatically comprehend an act upon the information that was sent to him. Semantic interoperability addresses all of these issues and the process of receiving and deciphering information from a sender.
HIMSS (Healthcare Information and Management Systems Society) sums up semantic interoperability with the following definition:
“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. 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.”
Essentially, semantic interoperability is the ability for two or more systems to effectively exchange, interpret, and use data and information.
The IEEE defines interoperability as the ability of two or more systems or components to exchange information and to use the information that has been exchanged.
Expanding on these definitions, there are several features that characterize a system as having semantic interoperability.
For a system to be considered interoperable, it must have homogenous elements and operate in a homogenous environment. Academic researchers Tarek Sboui et al define semantic interoperability as “a process to facilitate the reuse of geospatial data in a distributed and heterogeneous environment.” For this reason, standardized data formats and communication protocols are essential to interoperability effectiveness.
However, not all data will be homogenous. This is why the ability to standardize data is crucial. According to Sumit Sen, author of Class Structures and Lexical Similarities of Class Names for Ontology Matching, “there may be times that data must be translated quickly and accurately from one language to another. Semantic interoperability is the faculty of interpreting knowledge imported from other languages at the semantic level, i.e. to ascribe to each imported piece of knowledge the correct interpretation or set of models. It is a very important requirement for delivering a worldwide semantic web.”
The systems must all be able to integrate and support overall workflow. As stated previously, data must no longer be viewed as isolated packets, but rather fluid and integrated. The NCVHS states that “semantic interoperability is critical in facilitating health care delivery transformation because patient care typically involves a workflow comprised of related and dependent processes that cross institutional and computer system boundaries.” This requires schema mapping, data translation, and database integration.
With Semantic interoperability, the lab results we discussed in the previous article, would be securely transmitted to the LTPAC system, which will be able to verify the authenticity of the message in which they are contained, match the results to a patient and an order to perform such a test, extract each and every observation made by the lab, categorize the component that was observed, save the observation time, method, scale, and result, alert stakeholders if any abnormal or critical results were reported, provide users of the system with the ability to report on and trend these results, use these observations in combination with other clinical data about the patient to perform patient specific CDS, and conduct population health activities.