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The Difference Between Interoperability and Integration

In just a few short days – March 15, to be exact – we’ll take one more step toward understanding how the government will define “meaningful use.” That’s the last day the public will be allowed to comment on the proposals released in December that outline the meaningful use definition, as well as the various incentive programs. (Anyone who would like to view the comments, submit a comment, or link to the proposals can do so online.)

Meanwhile, every so often I hear a comment from all manner of intelligent, informed professionals that goes something like this: “What’s so hard about interoperability? Lots of hospitals and physician practices already have integrated practice management (PM) and electronic medical record (EMR) systems…”

Unfortunately, an important matter of semantics sometimes unwittingly leads us to heated debate or a dismissive, “They don’t know what they’re talking about!” attitude. It’s imperative to be aware that discussions of “interoperability” and “integration” can easily leave people talking apples and oranges without ever knowing it.

Here’s the reason: People from so many disparate backgrounds – technological, clinical, business, regulatory, governmental – all play a role in the current push to better automate healthcare. Everyone understands the generalities behind the idea of one HIT system “talking” to another, but most folks have no need to delve into nitty-gritty technical specifics. As a result, “interoperability” and “integration” have become broad-brush terms many of us use synonymously as a way to express the general concept of data connectivity.

However, these terms are not interchangeable at all to those deeply involved in the technical details necessary to bring about the transformation of HIT. Each term, in fact, has its own clearly distinct meaning.

Start with this carefully-wrought definition of interoperability created in 2005 by the Integration and Interoperability Steering Committee (I&I) of the Healthcare Information and Management Systems Society (HIMSS): “Interoperability means the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.”

HIMSS goes on to define six requisite dimensions for total interoperability, but this is the foundation. (From there, you should also understand that “semantic interoperability” drills down even further to describe when disparate systems not only share information, but allow receiving systems to understand/use incoming data while still preserving the data’s original “meaning.”)

Now take a look at the HIMSS definition of integration: “…arrangement of an organization’s information systems in way that allows them to communicate efficiently and effectively and brings together related parts into a single system.” As you can see, HIMSS differentiates between intra-organizational connectivity (interoperability) and inter-organizational connectivity (integration). Very different concepts.

So, when someone engages you in a serious discussion about interoperability or integration, it may be worthwhile to take a moment to be sure you’re both talking apples to apples. Are you speaking in generality, or in technical detail? Explain how you define the terms, and know how they define the terms as well.