Varieties of interoperability in the transformation of the health-care information infrastructure

Health-care costs are rising dramatically. Errors in medical delivery are associated with an alarming number of preventable, often fatal adverse events. A promising strategy for reversing these trends is to modernize and transform the health-care information exchange (HIE), that is, the mobilization of health-care information electronically across organizations within a region or community. The current HIE is inefficient and error-prone; it is largely paper-based, fragmented, and therefore overly complex, often relying on antiquated IT (information technology). To address these weaknesses, projects are underway to build regional and national HIEs which provide interoperable access to a variety of data sources, by a variety of stakeholders, for a variety of purposes. In this paper we present a technologist's guide to health-care interoperability. We define the stakeholders, roles, and activities that comprise an HIE solution; we describe a spectrum of interoperability approaches and point out their advantages and disadvantages; and we look in some detail at a set of real-world scenarios, discussing the interoperability approaches that best address the needs. These examples are drawn from IBM experience with real-world HIE engagements.