Why Interoperability Is Hard
This chapter explores some of the reasons why healthcare interoperability is hard and why standards are needed. Interoperability can be looked at as layers (technology, data, human and institutional) involving different types of interoperability, technical, semantic, process and clinical. Standards are needed to tame the combinatorial explosion of the number of links required to join up systems, but usually require translation to and from an interchange language. Users and vendors are not always incentivised to interoperate. Apparently simple things such as addresses are more complex than they seem. Clinical information in EHRs is inherently complex, but complexity and ambiguity in specifications creates errors. Any interoperability project involves change management.
KeywordsInteroperability definition Interoperability layers Technical interoperability Semantic interoperability Process interoperability Clinical interoperability Interoperability standards Combinatorial explosion Electronic health records (EHR) Translation Rosetta Stone Problem-oriented medical records (POMR) ISO 13606 Name Address Discharge summary Clinical laboratory reports GP2GP Complexity Errors Change management
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