HINF 510 Week 2 Systems and Interoperability Assessment Example

Twenty-Seven Systems, Eleven Interfaces and One Patient's Story Split Three Ways: A Systems and Interoperability Assessment Before a Health Center Network Replaces Its Record

[Student Name]

University of Phoenix

HINF/510: The Systems Life Cycle

Week 2 Assignment

[Instructor Name]

[Date]

The health center network, its systems and findings are composites written for a model paper; standards, rules and research findings come from the sources listed.

A 48-year-old patient at one of the network's clinics saw a physician for diabetes, a dentist for a tooth infection and a behavioral health consultant for depression, all on the same morning. The physician prescribed an antibiotic; the dentist, unable to see that order, prescribed another. The behavioral health note, kept in a separate system, never reached the physician. Her story was split three ways across the network's systems. Before designing its new electronic record, the composite 14-clinic community health center network assessed every system it uses and how well they share data. This paper presents that assessment.

Why Assess Before Designing

A new record will replace some systems and connect to others. Without a clear picture of what exists, what it does and how data move between systems, the design team risks rebuilding current problems in new software. The assessment took six weeks and involved the three project analysts, the information technology manager and interviews with 41 staff members.

The Inventory

The team found 27 systems, more than leadership expected. They included the medical record, a separate dental record, a separate behavioral health system, practice management and billing, a patient portal, a population health reporting tool, a telehealth platform, laboratory ordering through two reference laboratories, electronic prescribing, the state prescription drug monitoring program, the state immunization registry, the regional health information exchange, contract pharmacy software, a document scanning system, a patient messaging service, fax servers and several departmental tools such as a spreadsheet-based referral tracker and a mobile outreach van's standalone laptop.

Criteria

Each system was rated from one to five on six criteria: function (does it do what users need), data quality and completeness, integration with other systems, security, vendor support and viability and total cost. The ratings were reviewed with the users of each system to avoid scoring from the information technology department's view alone.

Findings on Core Systems

The medical record scored lowest on function and vendor viability. The dental and behavioral health systems scored adequately on function but lowest on integration: neither shared medication lists, allergies or problem lists with the medical record. Practice management scored well and could be kept for a transition period but would ideally be replaced by the new record's integrated module. The patient portal scored poorly with patients, with only 22% of adults activated.

Mapping the Interfaces

The team mapped 11 interfaces. Seven used standard HL7 version 2 messages, such as laboratory orders and results and immunization reports to the state registry. Four were custom-built by a former employee: the dental scheduling link, a nightly file from behavioral health to billing, a referral export and a population health data feed. None had current documentation, and two failed silently several times a month. An interface that fails silently is worse than no interface, because everyone assumes the data arrived.

Levels of Interoperability

Interoperability can be assessed at four levels. Foundational interoperability means one system can send data another receives. Structural interoperability means the data arrive in a defined format that the receiving system can parse. Semantic interoperability means shared codes give the data the same meaning in both systems, such as LOINC for laboratory tests, SNOMED CT for clinical findings and RxNorm for medications. Organizational interoperability means the policies, agreements and trust that allow exchange. The network's laboratory interfaces reached the semantic level; its dental and behavioral links barely reached the foundational level, sending a daily file of appointments without clinical meaning.

Standards for Modern Exchange

Newer standards make richer exchange possible. Consolidated clinical documents carry summaries between organizations, and FHIR represents data as modular resources available through web interfaces. An approach built on FHIR lets third-party apps run inside or alongside the record using standard authorization, so an app developed once can work across different vendors' systems (Mandel et al., 2016). The new record should support these standards natively.

External Exchange

The network exchanges data with hospitals, specialists, laboratories, the state and payers. A national framework published in 2022 set common rules for exchange among networks, aiming for a single on-ramp for providers to reach others nationwide (Office of the National Coordinator for Health Information Technology, 2022). The network's current record cannot participate; the new record should.

Barriers Beyond Technology

Exchange is also limited by behavior. A national survey of health information exchange organizations found that 55% reported electronic record vendors at least sometimes engaged in information blocking, most often by charging unreasonably high prices for interfaces, and 30% reported health systems doing so, most often by refusing to share (Everson et al., 2021). The network had experienced both: a vendor quote of $38,000 for a single interface and a hospital that would not send discharge summaries.

Sensitive Records

Some data carry extra protection. Records of substance use disorder treatment from federally assisted programs are governed by a separate federal rule, revised in 2024 so that one signed patient consent can now cover later sharing for care, billing and routine operations, much as HIPAA works, though these records still face tighter limits than other data when courts or investigators seek them (Substance Abuse and Mental Health Services Administration, 2024). The network's behavioral health program includes such treatment, so the new record must label these records, track consent and control redisclosure.

Nine Requirements for the New System

The assessment produced nine requirements: one shared record for medical, dental and behavioral health with common medication, allergy and problem lists; native HL7 version 2, clinical document and FHIR interfaces; support for the national exchange framework; standard code sets throughout; interface monitoring with alerts for failures; consent management for sensitive records; replacement of all four custom interfaces; a modern portal with mobile access; and integration of the outreach van through mobile devices rather than a standalone laptop.

Data Quality Findings

Interoperability depends on data quality. When the team sampled 200 patient records, 31% had medication lists that did not match the most recent visit note, 18% had duplicate allergy entries in slightly different wording and the dental and medical systems disagreed on the patient's preferred language in 12% of shared patients. Migration to the new record will carry these errors forward unless they are cleaned first, so the plan includes medication and allergy reconciliation at each patient's first visit after go-live, supported by pharmacy technicians.

Security Findings

Several systems scored poorly on security. The outreach van's laptop stored patient data locally without full-disk encryption, three departmental tools used shared logins and the fax server kept images of received documents for years without review. Fax remains common in exchanges with small practices and some agencies, so the new design routes faxes into the record's document queue and deletes server copies after indexing. These findings also feed the security planning described in a later paper.

What Will Be Retired

The new record will absorb 11 of the 27 systems, including the three separate clinical records, the referral spreadsheet and the population health tool. Retiring them removes interfaces, reduces licensing costs and ends duplicate documentation.

Conclusion

The assessment showed a network whose clinical story was divided among unconnected systems, joined by fragile custom interfaces and limited by external barriers. Rating each system consistently, assessing interoperability at every level and considering legal limits on sensitive data produced nine requirements that will shape the new record's design, so the next patient seen by three clinicians in one morning has one story in one place.

References

Everson, J., Patel, V., & Adler-Milstein, J. (2021). Information blocking remains prevalent at the start of 21st Century Cures Act: Results from a survey of health information exchange organizations. Journal of the American Medical Informatics Association, 28(4), 727-732. https://doi.org/10.1093/jamia/ocaa323

Mandel, J. C., Kreda, D. A., Mandl, K. D., Kohane, I. S., & Ramoni, R. B. (2016). SMART on FHIR: A standards-based, interoperable apps platform for electronic health records. Journal of the American Medical Informatics Association, 23(5), 899-908. https://doi.org/10.1093/jamia/ocv189

Office of the National Coordinator for Health Information Technology. (2022). Notice of publication of the Trusted Exchange Framework and Common Agreement. Federal Register, 87, 2800. https://www.federalregister.gov/d/2022-00948

Substance Abuse and Mental Health Services Administration. (2024). Confidentiality of substance use disorder (SUD) patient records. Federal Register, 89, 12472. https://www.federalregister.gov/d/2024-02544