Unstructured Data: A Missing Link to Healthcare Interoperability

By Colleen Sirhal, Director of Global Healthcare, Hyland Healthcare; a HIMSS Global Health Conference Executives Circle Collaborator

While achieving interoperability between disparate IT systems remains a priority among healthcare providers, integrating new technology with legacy systems and accessing unstructured data throughout the healthcare ecosystem continues to be a challenge.

This came across loud and clear in a second annual study that HIMSS conducted with the support of Hyland Healthcare: Connected Care and the State of Interoperability in Healthcare. Approximately 118 clinical and IT leaders from healthcare providers across the United States were surveyed and interviewed to gather the data for this study.

Based on the results, most providers feel they are making progress when it comes to establishing an interoperable health IT framework. For example, 75% of respondents ranked their interoperability progress as excellent or good.

Respondents were asked to further rate their progress based on four different “levels” of interoperability that ascend based on complexity. Once again, the results here are promising. Respondents ranked their organizations as being very successful or somewhat successful at achieving the following levels of interoperability.

  1. Foundational (93%): Allows data exchange from one system to be received by another, but does not require the ability to interpret data
  2. Structural (95%): Ensures data exchanges between IT systems can be interpreted at the data field level
  3. Semantic (82%): Provides interoperability at the highest level at the data element level, enabling the ability of two or more systems to exchange and use information
  4. Organizational (75%): Includes clear policy, social and organizational components to facilitate communication and use of data within and between organizations and individuals

Legacy Systems, Unstructured Content and Interoperability Challenges

Based on these figures, one might think that the healthcare industry may have finally figured out how to achieve true interoperability throughout the care continuum. However, upon further examination, the data shows that a few key obstacles are still standing in the way. One is integrating new technology solutions with legacy systems. Of the respondents, 59% listed the challenges associated with connecting new standards-based technology systems to legacy solutions that don’t support these new standards.

Another is managing unstructured data and content throughout the healthcare ecosystem. This includes identifying this information as well as making it easily accessible to key stakeholders throughout the healthcare enterprise. This was identified by 53% of respondents as a key obstacle to true interoperability stating that 73% of the unstructured patient data and content in their organizations is inaccessible by key clinical stakeholders for review and analysis.

This is a crucial problem because unstructured data is a key part of a patient’s overall medical history. It includes things like clinical documents and charts, clinical narratives, lab results, consents, referral documents and a wealth of medical images—even images from digital cameras, smartphones and scopes.

If this vital unstructured information is not included in the core clinical systems healthcare providers use every day, then the patient picture is woefully incomplete. In fact, industry estimates from analysts such as Gartner and IDC state that, even today, nearly 80% of the information that exists on a patient is in an unstructured format.

The providers themselves seem well aware of the problems this unstructured data disconnect causes, especially when it comes to medical images. For example, 90% of respondents stated that it was critical or very important for clinicians to have access to patient images at the point of care. However, respondents stated that an average of 18% of their images are captured offline (e.g., encounter-based, via mobile device, etc.). And most respondents (65%) cited that a direct integration with their radiology picture archiving and communication system (PACS) was their primary means of integrating medical images with their EMR. This leaves a potentially vast array of non-radiology images inaccessible from this core clinical system.

When unstructured content and images aren’t included in the IT systems that are central to interoperable infrastructures, then these interoperability efforts are incomplete.

Harnessing Unstructured Content for True Health IT Interoperability

Considering the importance of unstructured content in creating a comprehensive patient record, how can this information be harnessed to ensure it’s included in interoperability initiatives? While definitely a complex undertaking, the process can be boiled down to the following three steps:

  1. Identify: First, you need to identify where your valuable unstructured data currently resides. Often this information exists in multiple departmental enterprise content management systems, third-party cloud archives, paper medical documents and charts, faxes, email, specialty imaging systems, isolated modality stations, mobile devices, physical storage media and more.
  2. Consolidate: Next, steps need to be taken to consolidate this data as much as possible. A series of content services can be used to consolidate electronic documents from existing repositories and scan, index and archive paper documents into a consolidated repository. From a medical imaging perspective, enterprise imaging solutions, such as a vendor neutral archive, universal image viewer and image connectivity tools can be implemented to complement PACS. This approach enables centralized management, access and sharing of all types of images—regardless of format and source. Through standard data formatting, it also eliminates vendor lock and block that often accompanies proprietary systems, giving organizations all-encompassing ownership and control of their imaging data. These content services and enterprise imaging repositories can be further consolidated by establishing a single enterprise platform with a shared storage and presentation (i.e., viewing) layer.
  3. Connect: Finally, these consolidated repositories need to be integrated with core clinical systems such as the EMR using accepted industry standards such as HL7, Fast Healthcare Interoperability Resources (FHIR), DICOM, Cross Document Sharing (XDS) and more. The goal is to present as much of this unstructured data in a single view alongside structured data via the EMR interface and to make it easily accessible and sharable throughout the enterprise and beyond. If done right, you’ll take interoperability to the next level by not only sharing health information, but sharing complete patient information.

Sponsored content. The views and opinions expressed in this blog or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.

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