In part three of our blog series, you will learn how to successfully implement interoperability with i.s.h.med^® and how the i.s.h.med Interoperability solution supports clinical users within departments and across sectors.

The deadlines are tight and the bar is high when it comes to the successful implementation of end-to-end digital processes, as specified in Germany by the Telematics Infrastructure (TI) and the Hospital Future Act (Krankenhauszukunftsgesetz, KHZG). Yes, there is a strong push for digitalization in Germany, but the requirements are universal and a new standard-based interoperability layer to support especially semantic interoperability will benefit all global clients. Cerner solution portfolio users benefit from our global expertise, especially when it comes to cross-departmental and cross-sectoral networking of all players involved in the treatment process. However, this will only be successful if the data exchange works smoothly and all systems ‘understand’ the data. This brings us to the term of interoperability and part three of our blog series. We presented the term, its meaning and benefits in The role of interoperability – part one: Communication and understanding and The role of interoperability ‒ part two: Semantic interoperability is the highest discipline. This blog post is about the implementation of (semantic) interoperability in i.s.h.med. When it comes to development, our expert and i.s.h.med Interoperability lead solution leader Axel Biernat and his team have their finger on the pulse. He knows the challenges and introduces solutions intended to provide users with the best possible support in their everyday lives.

i.s.h.med Interoperability ensures seamless integration of systems and processes

“We want to develop an EHR that works like a USB port: you plug a device in, and it works. That's the route we want to take in terms of standardization and interoperability.” Axel Biernat shows how comprehensively integrated processes can improve everyday clinical work in the future – and today, with the first release of i.s.h.med Interoperability on 3 February 2022, supporting users in their key needs, especially in clinical healthcare. This allows users to retrieve and use information online and in real time at different locations and systems as part of the treatment of their patients. Using the HL7 FHIR international open standard, i.s.h.med Interoperability provides a REST API for first and fundamental resources. These can be consumed in any programming language with ease. This means data is available in an integrated form and can be exchanged across systems. “There is a free flow of information that can be used by the healthcare professionals involved for the optimal treatment of their patients,” Axel Biernat explains. The solution will also support complementary standards, such as SMART on FHIR, for application development related to electronic patient records.“FHIR is the current standard, but of course we continue to use the previously established version of the HL7 Version 2 standard with the existing MCI component in i.s.h.med,” adds Biernat, referring to users who have been working with this standard for a long time. Going forward, all health data – such as vital signs, allergy documentation, medication orders and related catalogs – will be available and interoperable via the continuum of care to everyone involved in treatment, based on appropriate access authorization. This includes integrated patients, who will have access to current information in their digital patient chart. A further added value element is created from the fact that standardized and interoperable available health data can be reused anonymously in the context of research and innovation according to the findable, accessible, interoperable, reusable (FAIR) principle.

Nothing works without terminology, ontology and classification

Interoperability is achieved when data is recorded in a structured and semantically unambiguous manner and when data can be exchanged between healthcare providers within facilities and across sectors. Systems for terminologies that create semantic links are an important prerequisite for this. i.s.h.med makes use of two internationally used standards: LOINC is used for examination and test results from laboratories and hospitals, while SNOMED CT is used for ontology, determining terminologies for illnesses, procedures, anatomy or pharmaceutical products. These are complemented by the ICD and OPS/ICPM classifications. The component contains a comprehensive and sophisticated terminology server that can also incorporate further standard terminologies or even local standards. With this in mind, i.s.h.med users can rest easy – and they will benefit from reduced implementation costs too.

With i.s.h.med Interoperability, a FHIR-based, integrated terminology server ‒ the Ontoserver from CSIRO ‒ is on course to be delivered as standard from February 2022. This option is also suitable for customers who would like to use this terminology solution independently of an EHR. In general, with the Cerner Terminology Hub, customers will be provided with a central platform for the distribution of terminologies, so that the effort involved in purchasing and maintaining their own systems will be significantly reduced.

Our partners benefit from open, MDR-compliant standards ‒ as well as from decreasing costs

i.s.h.med has a lot to offer ‒ both for users and partners. As a class I medical device – and designed as an open ecosystem with connectivity options for certified subsystems and solutions – it facilitates the development and easier integration of MDR-compliant products by partners. Renouncing proprietary technologies is part of the philosophy of i.s.h.med and enables developers of partner solutions and customers to use them as easily as possible. Axel Biernat explains, “By means of APIs, we enable partners and customers to develop their own solutions in the context of i.s.h.med and interoperability. At the same time, by using APIs in i.s.h.med Interoperability, third-party providers do not have the risk of modifying medical devices through their connection.” According to Biernat, the concept known as ‘API economy’ means that, in addition to significantly lower implementation costs, the total operating costs for users can also be expected to decrease permanently. Based on HL7 FHIR interfaces and equipped with internationally used terminology standards, i.s.h.med, as an open EHR platform, offers the possibility of interoperable expansion as required and in accordance with regulatory requirements. i.s.h.med Interoperability is based on experiences from global best practices, which is a huge advantage for customers and developers of partner solutions.

i.s.h.med Model System as the basis for further developments

At the same time, the agile i.s.h.med Model System process model (see previous blogs) provides a benefit in this context. For Germany, this applies to all content related to TI and the KHZG: the end-to-end digitalization of all clinical core processes, which the KHZG must fulfill by 2024 according to the approved funding criteria. “We deliver, among other things, the IHE profiles and FHIR implementation guides, which describe exactly how a specific process is to be mapped,” explains Axel Biernat. This is because the integration effort for users should be kept as low as possible ‒ and thanks to automatically delivered updates in the updated solution from i.s.h.med Interoperability, it can be smartly integrated into everyday clinical work.