Addressing Challenges with Interoperability

Addressing Challenges with Interoperability

The usage of technology has become ubiquitous in all health care spheres since the turn of the present decade. Health care facilities have embraced the usage of this phenomenon to ensure that patient data is shared seamlessly across difference geographical locations, systems and departments within a hospital. At the core of the implementation of health care interoperability is the electronic health record system. The interconnectedness of this system makes it easier for various stakeholders within the health care sphere to access and share pertinent patient data during assessment and treatment processes. However, even with the adoption of this interconnected network to enhance sharing of patient information and generally improve the quality of care, challenges still abound in the usage of such systems. Appreciating these challenges thus becomes an important aspect of seeking solutions in order to make interoperability a reality in health care. To this end, the present paper will identify an interoperability challenge, identify the root cause of the same using workflow structure, and then offer a workable solution to it using evidence-based literature.

Identification of the Problem

            The issue of patient billing has experienced some avoidable technicalities as regards health care interoperability within hospital settings. One of the most affected aspects of the entire process involves health care billing. During one of my nursing care shifts at the intensive care ward, I wanted to bill a patient using the hospital’s EHR database system. As with all other hospitals, the final billing of critical care cases entail recording the entire supplies utilized during the treatment process, which may involve surgical supplies (Kohler, 2015). The availability of such information helps in summing up the bill accrued by a patient upon their discharge or, in unfortunate cases, death. However, when pulling out the information on the list of surgical supplies used by the patient, I experienced a delay that lasted forever without resolving. When the IT technician was summoned, she could not resolve the issue only to later identify that a security breach of the system had occurred.

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A further analysis of the issue revealed that the entire database hosting patient information had been compromised. As a consequence, over one hundred and fifty patient files had gone missing from the database. This had impacted several health care personnel, from nurses, to physicians to pharmacists, who could not prescribe drugs while the former personnel could not perform their duties on these patients as pertinent information regarding their conditions was missing. Thus, essentially, the workforce at the facility could not treat or care for the patients at various levels due to missing data concerning their medication dosages, the evaluation of progress, and even prescription of new drug regimen at the facility due to the system breach.

Analysis of Workflow and Structure Associated with the Security Breach

The diagnosis of the issue revealed the existence of a malware at the hospital’s EHR system’s central server unit. Apparently, a hacker had compromised the multi-patient monitors for the entire patient registry and deleted certain files belonging to the 150 patients that were affected. The anonymous hacker achieved this through the introduction of a malware into the system (Rezaeibagha, Khin & Susilo, 2015). However, the normally active events-drive alerts did not work as the hacker had disabled it prior to accessing the system. The coding of the malware had been done such that it was instructed to coordinate the execution of workflow commands from the intensive care wards to the principal server at the facility’s records unit minus compromising data from other wards. As a consequence of this omission in the attack, it was not easy to detect that the files from the intensive care wards had been compromised since the hacker deployed the virus into the hospital’s EHR workflow management system.

Moreover, the notification alerts did not occur as the hacker had disabled it enabling the malware to become integrated into the HER management system related to the intensive care ward patients as initially stated. Whereas the possibility of a human handler integrating the malware into the system was high, the system was already vulnerable to attacks since it was operating on a public network (Friedman, Parrish, & Ross, 2013). The usage of this network was such that the integration of the systems between different departments from the central server unit could occur seamlessly. Further, such an arrangement made it easier for EHR’s Application Programming Interface vendors to readily exchange data between disparate systems. In this facility, audit trails concerning data from the intensive care unit are not difficult to undertake as the on-premise systems housed the data maps at a central point. However, the detection of the hacker did not occur as they appeared well-versed with the system.

Recommended Solution to the Security Breach

            In most cases, problems occurring as a result of security breaches can be resolved through the Root Cause Analysis kit. The principle behind the working of the tool is enveloped in its capacity to ensure that workflow systems run unhindered and identify hazards along the EHR interoperability system. Vernier (2015) revealed that the root cause analysis tool kit was successfully applied in coordinating the structures of hospitals for purposes of anticipating potential challenges in patients’ published accounts by the infection control teams (ICTs). A study by Franoic et al. (2018) also revealed that root cause analysis ensures patient safety is guaranteed in hospitals through preventing malicious incidences such as hacking when applied in hospital HER systems. Bowie, Skinner, and de Wet (2013) also conducted a study, which revealed that training health care professionals in root cause analysis helps in the identification of issues that could jeopardize the safety of patients hence preventing disasters.


Therefore, whereas hospitals have adopted technologies such as EHR into their system, the interoperability of such systems has some challenges. Issues such as security breaches have dogged them making it important to seek for solutions. According to studies, conducting a root cause analysis could help health care settings prevent future happenstances of these challenges.



Bowie, P., Skinner, J., & de Wet, C. (2013). Training health care professionals in root cause analysis: a cross-sectional study of post-training experiences, benefits and attitudes. BMC Health Services Research, 13(1), 1–10.

François, P., Lecoanet, A., Caporossi, A., Dols, A.-M., Seigneurin, A., & Boussat, B. (2018). Experience feedback committees: A way of implementing a root cause analysis practice in hospital medical departments. PLoS ONE, 13(7), 1–12.

Friedman, D. J., Parrish, R. G., & Ross, D. A. (2013). Electronic Health Records and US Public Health: Current Realities and Future Promise. American Journal of Public Health, 103(9), 1560–1567.

Kohler, C. (2015). Physician Practice Billing From A to Z. Brentwood, TN: HCPro, a division of BLR. Retrieved from

Rezaeibagha, F., Khin Than Win, & Susilo, W. (2015). A systematic literature review on security and privacy of electronic health record systems: technical perspectives. Health Information Management Journal, 44(3), 23–38.

Venier, A. G. (2015). Root cause analysis to support infection control in healthcare premises. Journal of Hospital Infection89(4), 331-334. France: Elsevier.


In the current healthcare system, the consistently growing technology is becoming a big challenge. Interoperation has posed a significant impact on the healthcare delivery for both the care provider and the patient. For its significance to be well understood, it is important for providers to appreciate its present landscape. Currently, healthcare providers are facing several challenges such as data sharing restrictions, costly interface fees, lack of standardized data formats especially in disparate systems, reduced reimbursements and resource and time constraints (Randall et al., 2018; Porter-O’Grady & Malloch, 2016). Combining all these items with the need of moving towards value-based care, it is necessary to solve these challenges.

The Problem with Lack of Interoperability

For example, in the previous healthcare facility that I used to work, laboratories and the entire healthcare system were making substantial operational and monetary investments in the engines interface and development resources with the intent of making the EHR software communicate to the laboratories. The healthcare facility had other complex requirements that if the implementations of the interface were delayed, there would be additional costs in hiring expensive labor to complete the project (Adler-Milstein, 2017). Every time a team was formed to develop and implement these interfaces, tremendous amounts of resources and time would be spent, even when other hospitals were benefiting from the interoperability systems. Unfortunately, as the challenge remained unresolved, the hospital continued to allocate vast portions of its budget towards the project even when they were already strapped.

Workflow and Structure

EHR has done a tremendous job in capturing, storing, and transmitting data. Their shortcoming is, however, exposed in clinical workflows. Let’s say a patient visits the hospital in subsequent years and receives treatment from their primary care provider as required and their records stored. When the same patient comes back after several years, and their primary caregiver had used different EHRs documents, then it will become very difficult to track down the course of treatment of this patient in the past years (Ross, Stevenson, Lau, & Murray, 2015). With interoperability between these EHR systems, the patient will not only experience improved care but also reduced tests and costs with perfect care plan based on previous medical history.

Potential Solutions to the Problem

To manage these challenges, there is a need to reduce costs wherever possible for future profitability and success for both the ambulatory practices and the healthcare system. Costs can be reduced through the implementation of the right interface strategy. Modern health engines which act as a central hub for all the hospital transactions are available for enterprise-wide interoperability as evidenced by the work of Randall et al. (2018). With such technology, the hospital’s labs, clinics, and radiology centers will stop reinventing the old wheel and begin to reuse interfaces that are already developed. Additionally, they help to reduce hiring costs of interface developers who request high salaries and ambiguous interface engine fees.

Utilization of referral systems can also help the healthcare system achieve more interoperable workflow. Referral systems help in streamlining the flow of patient’s referrals among providers enhancing communication and the relationship between all healthcare providers while coordination patients care. Theses referral systems are integrated with both ambulatory and acute EHRs hence facilitates interoperability for sharing patients and clinical data in order to ensure quality as demanded by the IOM report (DeNisco & Baker, 2016). Retrieving and storage of data have been crucial to patient care (Ross, Stevenson, Lau, & Murray, 2015). With proper access and transfer of information, healthcare providers will not only be able to consult but also maintain a good relationship with their patient, hence providing high-quality care, of which the patient has been a part of.

For a permanent solution, I would recommend for further advancement of the system. The enterprise-wide master patient index (EMPI) system was designed to maintain an accurate, consistent, and current medical data of the patient and demographic data across several healthcare departments. The system has been used by a number of healthcare organizations and has proven to positively impact workflows, reduce costs, and transform health towards patient-centered care.  The matching capabilities of patients and the EMPI systems will also result in a more significant change in the patient’s experience and clinical workflow. The primary outcome of these advancements will provide a complete picture of the future health of the patients by helping providers spot and bridge the gaps in patient care (Ross, Stevenson, Lau, & Murray, 2015). Consequently, these advancements also provide insight into patients suffering from chronic illnesses, helping in reducing readmissions, and assisting in the calculation of risks adjustment scores for medical advantage.


In conclusion, as interoperability helps in enhancing providers’ workflow, it also helps in making the patient feel more involved in their own care. It is thus very important to overcome the challenges faced in order to advance the system for maximum benefits. Additionally, advanced technical opportunities and steps to further interoperability will help most healthcare organizations reduce costs and sustain productivity while at the same time maintain focus towards the patient. Based on the actual connection between systems which provide actionable data, interoperability will result in healthcare providers to offer patient-centered care in a drastic value-based healthcare world.


Adler-Milstein, J., Embi, P. J., Middleton, B., Sarkar, I. N., & Smith, J. (2017, January, 01). Crossing the health IT chasm: considerations and policy recommendations to overcome current challenges and enable value-based care. Journal of the American Medical Informatics Association: Jamia, (24)5, 1036-1043.

DeNisco, S. M., & Baker, A. M. (2016). Advanced practice nursing: Essential knowledge for the

     profession (3 ed.). Burlington, MA: Jones & Bartlett Learning.

Porter-O’Grady, T. & Malloch, K. (2016). Becoming a professional nurse. (2nd ed.), Leadership in nursing practice: Changing the landscape of healthcare. Burlington, MA: Jones and Bartlett Learning.

Randall, C. J., Sathitratanacheewin, S., Starks, H., Lee, R. Y., Kross, E. K., Downey, L., Sibley, J., … Lindvall, C. (2018, March, 01). Using Electronic Health Records for Quality Measurement and Accountability in Care of the Seriously Ill: Opportunities and Challenges. Journal of Palliative Medicine, 21.

Ross, J., Stevenson, F., Lau, R., & Murray, E. (2015, April, 13). Exploring the challenges of implementing e-health: a protocol for an update of a systematic review of reviews. Bmj Open, (5), 4.