Interoperability: what we can learn from overseas

All around the world, governments are recognising the importance – sometimes describing this as a right – for people to be able to have their records move seamlessly across organisational, state and even national boundaries.

The US has recently announced a draft interoperability framework called the Trusted Exchange Framework, or TEF for short. That’s an important step forward for digital health in the US, and one that the Australian digital health community should pay attention to. Let’s put the local angle aside for a moment and talk about the TEF itself.

At present, many US healthcare organisations need to join multiple health information networks to share data, but these networks do not share data with each other. While this supports flow of information within the networks, data interchange outside the networks is patchy, with silos of healthcare information arising that could if better connected, could improve healthcare and even save lives in some instances.

To address this problem, the TEF has laid out the following goals:

  1. Build on and extend existing work done by the industry
  2. Provide a single “on-ramp” to interoperability for all
  3. Be scalable to support the entire nation
  4. Build a competitive market allowing all to compete on information services
  5. Achieve long-term sustainability

The overarching method of achieving these goals is to connect different health information networks through a core of super networks called Qualified Health Information Networks that connect with each other and thereby provide a bridge between competing health information networks. See the TEF User’s Guide for a user-friendly summary.

Meanwhile, the EU has adopted a regulatory framework called the General Data Protection Regulation – GDPR for short. This is a vast regulatory framework that individual countries will work within as they develop and implement their own national interoperability schemes. Of particular relevance for us here are the Article 20 “data portability provisions”, which stipulate that a person shall be able to transfer their personal data from one electronic processing system to and into another, without being prevented from doing so by the data controller.

This stipulation means that for the EU, full interoperability is a fundamental requirement for any national implementation. In contrast, full interoperability is the aim of the US approach, and a strategic priority of the Australian approach.

So how is all this relevant to the Australian digital health scene? First, local health IT developers should definitely familiarise themselves with the TEF and GDPR if they wish to develop solutions that are applicable to those markets. The Agency keeps abreast of international requirements and aims to align Australian requirements where possible, to assist local developers to compete in international markets.

Second, different technical solutions to common problems are always of interest, since they may inspire new approaches to our own issues. In particular, we might draw some analogies between our My Health Record and the Qualified Health Information Networks. Both play a role in unifying disparate underlying systems, but they are very different solutions. What are the strengths and weaknesses of the two approaches? And can we learn from the different approaches to improve our own?*

The task of implementing and improving digital health is a global effort, as each country develops its own solutions to its own unique environment. It’s important that we do not do so in isolation and continue to learn from other endeavours. Australian consumers will want access to applications developed for larger markets, and Australian industry should be supported to develop innovations for Australia that are competitive in international markets.

Footnotes

*And we will be able to ask similar questions in relation to GDPR-compliant implementations, when they become available.