Standards-based Interoperability Streamlines Clinical and Administrative Processes Across the Care Continuum
Healthcare organizations worldwide use InterSystems products for interoperability and improved workflow across the care continuum. Our support for global and national standards and certifications is one reason for this success. InterSystems is a member and benefactor of the HL7 standards organization.
Standards supported by InterSystems products include:
Tasked with improving health outcomes for Australians through the delivery of digital healthcare systems and the national digital health strategy for Australia, the Australian Digital Health Agency (the Agency) commenced operations on 1 July 2016.
The Agency is responsible for all national digital health services and systems, with a focus on engagement, innovation and clinical quality and safety. Its goal is to put data and technology safely to work for patients, consumers and the healthcare professionals who look after them.
In healthcare, ASTM (American Society for Testing and Materials) is a set of standards used in the transfer of information between clinical instruments and computer systems.
CDA® and CCD®
CDA (Clinical Document Architecture) and CCD (Continuity of Care Document) are specifications from the HL7 organization. According to HL7, CDA is an XML-based “document markup standard that specifies the structure and semantics of ‘clinical documents’ for the purpose of exchange between healthcare providers and patients.” CCD is “an implementation guide for sharing Continuity of Care Record (CCR) patient summary data using… CDA. CCD establishes a rich set of templates representing the typical sections of a summary record….”
According to the HL7 organization, “The Consolidated CDA (C-CDA) implementation guide contains a library of CDA templates, incorporating and harmonizing previous efforts from Health Level Seven (HL7), Integrating the Healthcare Enterprise (IHE), and Health Information Technology Standards Panel (HITSP). It represents harmonization of the HL7 Health Story guides, HITSP C32, related components of IHE Patient Care Coordination (IHE PCC), and Continuity of Care (CCD).
The Digital Imaging and Communications in Medicine (DICOM) standard is used to ensure the interoperability of systems that produce, store, display, process, send, retrieve, query or print medical images, and to manage related data and workflow.
Direct Secure Messaging
The Direct Project was created to specify a simple, secure, scalable, standards-based way for participants to send authenticated, encrypted health information directly to known, trusted recipients over the Internet. Direct focuses on the technical standards and services necessary to securely push content from a sender to a receiver and not the actual content exchanged. For example, a primary care physician who is referring a patient to a specialist can use Direct to provide a clinical summary of that patient to the specialist and to receive a summary of the consultation.
DMP (Dossier Médical Personnel) is the Internet-accessible French national electronic health record aimed at improving health information sharing and care coordination. Electronic medical record and other clinical systems communicate and share data with DMP via published specifications based on the French health information systems interoperability framework (CI-SIS), which is itself based on IHE profiles.
The Electronic Data Interchange For Administration, Commerce, and Transport standard (EDIFACT) is also known as the International Standards Organization (ISO) Standard ISO 9735-6. United Nations rules for EDIFACT comprise a set of internationally agreed standards, directories, and guidelines for the electronic interchange of structured data, and in particular that relate to trade in goods and services between independent, computerized information systems. In healthcare EDIFACT is used primarily for exchange of administrative data.
The eHealth Exchange is a rapidly growing network of exchange partners who securely share clinical information over the Internet across the US, using a standardized approach. By leveraging a common set of standards, legal agreement and governance, eHealth Exchange participants are able to securely share health information with each other, without additional customization and one-off legal agreements. The eHealth Exchange connectivity spans all 50 states and is now the largest HIE Network in the US.
InterSystems and a growing number of organizations have adopted the FHIR (Fast Healthcare Interoperability Resources) standard, originally specified by the HL7 organization. When fully specified FHIR will complement other standards, such as those from IHE, which are essential for interoperability and exchange of complete health information documents today. In the near term FHIR will play a major role in granular exchange of health information in mobile applications.
HL7 Version 2 and 3
Health Level Seven (HL7) was developed as a standard language for the sharing and integration of electronic health information.
You can learn more about our support for HL7 here.
Integrating the Healthcare Enterprise (IHE) is focused on improving the ways computer systems in healthcare share information, and is the de-facto standard for complete and composite health information exchange. The IHE organization continually improves these interoperability standards, and current IHE certification of products is essential for ensuring interoperability. IHE certification goes beyond what’s demonstrated at a single “connectathon” event (another important test of interoperability) and is more reflective of a product’s ability to interoperate, right now, in the real world (see our IHE integration statement and certifications).
The Interoperability Toolkit (ITK), developed by the United Kingdom’s National Health Service (NHS), is a set of common specifications, frameworks and implementation guides to support interoperability within local organizations and across local health and social care communities. ITK uses open international standards and is aligned with HL7 and Integrating the Healthcare Enterprise (IHE).
InterSystems was the first company to receive official accreditation for its ITK implementation.
My Health Record
The Australian Government’s My Health Record is the new name for the Personally Controlled Electronic Health Record system. A My Health Record is a digital health record for a patient that contains a summary of their health information. It is a key element of the national health reform agenda around making the health system more agile and sustainable.
With the introduction of the My Health Record system, healthcare organisations will have faster, easier access to more health information, creating a more efficient system, making continuity of care easier and improving treatment decisions.
NCPDP is an organization providing standards for information exchanges related to medications, supplies, and services within the healthcare system. These standards help improve safety, privacy and healthcare outcomes for patients and healthcare consumers, while reducing costs in the system.
SS-MIX (Standard Structured Medical Information eXchange) is a standard for health information exchange published by the Japanese Ministry of Health, Labor and Welfare. SS-MIX is based in part on HL7.
X12 is a standard for business-to-business electronic data interchange (EDI). It covers business transactions such as order placement and processing, shipping and receiving information, invoicing, payment and cash application data, and data to and from entities involved in finance, insurance, transportation, supply chains and state and federal governments.
xDT is a set of standards used in Germany for the exchange of health information between healthcare providers and insurance companies.
FHIR solutions are built from a set of modular components called “Resources” (such as encounter, patients, observation, medications, and so on). These resources can easily be assembled into working systems that solve real world clinical and administrative problems at a fraction of the price of existing alternatives.
InterSystems products provide all the technology needed to easily handle FHIR requests. This includes FHIR client and server components, a FHIR message model, and translation between FHIR and other health information interchange standards, such as HL7v2 and C-CDA.
HL7, FHIR and the FHIR Flame are the registered trademarks of Health Level Seven International.
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Healthcare organizations worldwide use InterSystems’ technology to seamlessly integrate information inside and outside the hospital while streamlining clinical and administrative business processes.
HealthShare, for example, combines HL7 messaging with support for additional protocols such as X.12, SOAP, and IHE Profiles. Together with its advanced integration and development capabilities, HealthShare enables you to create connected healthcare environments within a hospital or across the community.
InterSystems HL7 messaging and interfacing technology provides:
- Support for HL7 version 2.X and 3
- Support for HL7 CDA R2 (Including Consolidated CDA)
- Support for Multiple IHE Profiles (see our IHE integration statement and certifications)
- Pre-configured, customizable HL7 message router and HL7 version 2.X schemas to get you started quickly
- An embedded database that persists messages and guarantees message delivery
- Event driven, publish/subscribe, and content-based routing
- Graphical editor for transforming messages and data
- Rules engine that enables changes to running HL7 interfaces without programming
- Testing service for validating interface components
- Visual Trace, graphically showing message paths and content, for easier troubleshooting
- Message searching and re-send, with search by interface, date/time, message type, and content
- Operations monitoring with a single view into the status of inbound and outbound messages, message queue counts, and events
- Dynamic alert routing and delivery
- HL7 Sequence Manager to ensure that messages are routed in the sequence established by the sender
“HL7,” “Health Level Seven,” and the puzzle design are registered trademarks, and the HL7 design is a trademark of Health Level Seven International.
IHE and eHealth Exchange Certifications
Certified interoperability has a special role within healthcare. No other industry has really faced or addressed a problem similar to the sharing and aggregation of complex data records, specifically patient records, among multiple applications. Certification is the main means for ensuring success in real-world interoperability scenarios.
Simply saying that a product supports a given standard isn’t good enough. Different implementations of a standard may vary, causing problems when it comes to actually using it.
Solving Interoperability Challenges
No other industry has faced a problem similar to the sharing and aggregation of complex data records, specifically patient records, among multiple applications. Certification is the main means for ensuring success in real-world interoperability scenarios. Simply saying that a product supports a given standard isn’t good enough.
InterSystems is committed to the use of worldwide interoperability standards and has been tested and received certifications from:
- IHE USA and ICSA Labs
- eHealth Exchange
IHE Integration Statements
InterSystems is committed to the IHE’s objectives which are focused on improving the ways in which computer systems in healthcare share information. IHE is becoming the de-facto means through which health information is exchanged, and InterSystems products utilize IHE profiles extensively within their framework. InterSystems will continue to actively support IHE in its ongoing efforts to define and certify the standards that can transform sharing concepts into reality.
- InterSystems IRIS for Health
- HealthShare Health Connect
- HealthShare Unified Care Record (formerly Information Exchange)
- HealthShare Patient Index
HealthShare is certified for Health IT interoperability by IHE USA and ICSA Labs
HealthShare was among the first healthcare IT products to receive interoperability certification – helping healthcare organizations move forward on the path to connected care. This certification goes beyond what’s demonstrated at “Connect-a-thons,” being a more rigid demonstration of IHE testing and is much more reflective of being able to interoperate in the real world.
HealthShare achieved certification following rigorous and thorough testing under the IHE IT Infrastructure Domain, which specifies capabilities related to interoperability, clinical-document sharing, patient identification, audit logging, and security.
eHealth Exchange Validation
InterSystems HealthShare has successfully completed the eHealth Exchange Product Testing Program. eHealth Exchange has its roots in the Nationwide Health Information Network (NwHIN) effort of the U.S. federal government under the Office of the National Coordinator.
ONC Health IT Certification
HealthShare has received ONC Health IT Certification as an electronic health record (EHR) module for ambulatory and inpatient settings. A benefit of this certification is that HealthShare can be used by organizations to achieve and demonstrate Meaningful Use stages 2 and 3 (now called Promoting Interoperability).
ONC Health IT Certification 2015 Edition
This Health IT Module is 2015 Edition compliant and has been certified by an ONC-ACB in accordance with the applicable certification criteria adopted by the Secretary of Health and Human Services. This certification does not represent an endorsement by the U.S. Department of Health and Human Services.
- InterSystems Personal Community 12.2 was certified on August 10, 2017 with certification ID number 15.04.04.1727.Heal.PC.0.1.170810
- InterSystems Information Exchange 15.03 was certified on August 10, 2017 with certification ID number 15.04.04.1727.Heal.IE.0.0.170810
|Certification Criteria||Product Name and Version|
|HealthShare Unified Care Record 2019.2||Personal|
|HealthShare Unified Care Record 2019.1||Personal|
|170.315 (a)(13): Patient-Specific Education Resources||✓||✓||✓|
|170.315 (d)(1) Authentication, Access Control, Authorization||✓||✓||✓||✓||✓||✓|
|170.315 (d)(2) Auditable Events and Tamper-resistance||✓||✓||✓||✓||✓||✓|
|170.315 (d)(3) Audit Report(s)||✓||✓||✓||✓||✓||✓|
|170.315 (d)(5) Automatic Access Time-out||✓||✓||✓||✓||✓||✓|
|170.315 (d)(6) Emergency Access||✓||✓||✓||✓||✓||✓|
|170.315 (d)(7) End-User Device Encryption||✓||✓||✓||✓||✓||✓|
|170.315 (d)(9) Trusted Connection||✓||✓||✓|
|170.315 (e)(1) View, Download, and Transmit to 3rd Party||✓||✓||✓|
|170.315 (e)(2) Secure Messaging||✓||✓||✓|
|170.315 (e)(3) Patient Health Information Capture||✓||✓||✓|
|170.315 (g)(1) Automated Numerator Recording||✓||✓||✓|
|170.315 (g)(4) Quality Management System||✓||✓||✓||✓||✓||✓|
|170.315 (g)(5) Accessibility Centered Design||✓||✓||✓||✓||✓||✓|
|170.315 (g)(6) Consolidated CDA Creation Performance||✓||✓||✓|
|170.315 (g)(7) Application Access-patient selection||✓||✓||✓|
|170.315 (g)(8) Application Access-data category request||✓||✓||✓|
|170.315 (g)(9) Application Access-all data request||✓||✓||✓|
InterSystems Contact Information:
Address: 1 Memorial Drive, Cambridge, MA 02142
Additional Software Used for Certification: Secure Exchange Solutions SES Direct (HISP); required for Personal Community only.