Interoperability in the Mexican Healthcare System

As populations around the world age and new diseases emerge, interoperability and data sharing are becoming increasingly critical for delivering effective healthcare. These tools are already promoting closer collaboration among industry stakeholders, while new companies promise to bring to technologies to the market.

Interoperability is the ability of two or more systems to exchange information and use it once it is received. For health systems, according to the US National Coordinator for Health Information Technology (ONC), it will take time for all types of IT to be fully interoperable. But, when interoperability and widespread exchange of information is achieved, “providers will have the infrastructure to deliver patient-centered, value-driven care that improves health outcomes while reducing costs.”

The immediate benefits of interoperability include coordination, higher performance and better experiences for providers and patients, according to IBM. With access to data, clinicians have an easier time accessing a patient’s most important health information, leading to fewer repeat tests, preventing inadvertent treatment interactions and reducing miscommunications. “Interoperability makes it possible for organizations to study data trends, past performance and make data-driven improvements in patient care and other areas,” said IBM.

As the primary goal is to integrate the entire health system, the benefits go beyond immediate patient outcomes. Interoperability, explained by IBM, aims to give visibility to health plans for better resource utilization, provide data to determine health trends, leverage robust data based on research and reduce the amount of redundant administrative work for a more satisfying experience both for employees and patients.

Interoperability is the new trend at the center of innovation in health systems. Deloitte explained that it is a process that will likely take 20 years to be fully active. Nonetheless, different levels of interoperability are necessary to begin transforming health systems around the world to shorten the transition.

The Healthcare Information and Management Systems Society (HIMSS) enlisted four levels of interoperability:

1. Foundational: Establishes the interconnectivity requirements needed for one system or application to securely communicate data to and receive data from another.
2. Structural: Defines the format, syntax and organization of data exchange including at the data field level for interpretation.
3. Semantic: Provides common underlying models and codification of the data including the use of elements with standardized definitions from publicly available value sets and coding vocabularies, providing shared understanding and meaning to the user.
4. Organizational: Includes governance, policy, social, legal and organizational considerations to facilitate the secure, seamless and timely communication and use of data both within and between organizations, entities and individuals. These components enable shared consent, trust and integrated end-user processes and workflows.

Data about individuals, populations, institutions and the environment is at the heart of these four levels. “For interoperability, it is essential to guarantee that patient information is digitized in standard and secure formats. By enabling the storage and computation of massive data sets, healthcare organizations can easily store, integrate and analyze vast amounts of data. This improves patient outcomes by 95 percent,” said Esteban Lopez, Market Lead Healthcare & Life Sciences, Google Cloud Americas.

Health data has its own management guidelines to make the most of information, ensure data protection and avoid breaches when sorting the information. Health data, by nature, “has always been challenging to access and share securely. It is difficult to share because it is sensitive and requires a high level of privacy and security, yet the inability to access it when it is needed has the potential to cause significant harm,” explained IBM.

To date, the most common example of health data management systems and the first step to interoperability are Electronic Health Records (EHR), which compile data from multiple sources into one central hub for a comprehensive view of the patient’s history. EHRs provide patient documentation in a digital format thus allowing providers to record and store patient information in a centralized location and securely share that information with other caregivers.

For data from EHR and other sources to be correctly utilized by providers and patients, Javier Jiménez, Vice President Latam and Government, Health Gorilla, explained that regulations are needed. ”We need to obtain the governance, data-usage agreements and trust of each participant in interconnectivity processes.” According to Jimenez, technology is not a big barrier as long as we are dealing with standards such as Health Level Seven (HL7), an international standard for the transfer of clinical data. Penetration of such practices is still lacking, however. “While it is a standard, not every hospital or laboratory has the same internal resources and processes, so we need to determine where the data is and how to exchange it,” he said.

HL7 represents Fast Healthcare Interoperability Resources (FHIR), which are a standard protocol that “connects applications moving quickly in the network that need simple, transparent and efficient communication in a web platform,” said Víctor Medina, President, Health Level Seven México (HL7). The FIHR protocol is an API that enables the connection between two or more applications simply, using resources that establish what, how and in what language apps communicate information. The need for a true interoperable digital health ecosystem that includes e-prescriptions, telemedicine, drug codes and EHR is what brought HL7 to Mexico, according to Medina. “Mexico needs a standardization mechanism to keep up to date with a large amount of innovation emerging and the fast speed at which Medtech is moving forward.”

Aside from this regulatory challenge, the entire health system faces a joint obstacle to allowing interoperability. “Within the health and life sciences sectors, the great challenge is to obtain correct and valuable information, which requires significant time and resources with expertise in AI and ML,” said to Igor Fermin, Principal Adviser Healthcare and Life Sciences, Google Cloud Latam. Data engine solutions that target these problems exist, but these require companies and countries to invest time and resources in solving such matters.

The Mexico City Ministry of Health recently announced the digitization and real-time shared access project to patient data in Mexico’s capital among 30 hospitals that serve a population of 4 million. “Thanks to ehCOS technology platform, all systems in the 30 hospitals have become interoperable with each other in just two years, increasing patient safety and continued care. This has also increased the efficiency of the healthcare system and decreased retesting costs since this information is now shared and used in real-time,” states a release from ehCOS.

For interoperability processes to work national wide, the ONC stresses four primary principles:

• Trust to guide health information exchange governance entities on patient privacy, meaningful decision-making and data management in health information exchange.
• Business focus on responsible financial and operational policies for governance entities, with emphasis on transparency and health information exchange to keep the patients’ best interests in mind.
• Technical principles to define priorities for the use of standards to support the Trust and Business Principles, as well as furthering interoperability execution.
• Organizational principles to identify generally applicable approaches for good self-governance.

This Integration of health ecosystems will bring benefits to everyone involved, including the government, public institutions, private sector and ultimately, the patient, who is the “guiding thread” of the industry, according to Jesús Díaz Garaygordobil, CIO, CHRISTUS MUGUERZA. Furthermore, interoperability is fundamental for technology to become a standard practice in medicine. “Interoperability among all actors is essential because it would allow all companies to offer a better service,” according to Arturo Jain, CTO and Co-Founder, Nubix.