ASHP Reports Informatics terms
ASHP reports
Suggested definitions for informatics terms:
Interfacing, integration, and interoperability
Rhonda McManus, Eric C. Nemec, Darren S. Ferer, Section Advisory Group on Pharmacy
Operations Automation (2010–11), Section of Pharmacy Informatics and Technology
Executive Committee (2011–12), and Karl F. Gumpper
Am J Health-Syst Pharm. 2012; 69:1163-5
T
he authors, in collaboration
with the ASHP Section Advisory
Group on Pharmacy Operations
Automation, developed suggested
standard definitions for three terms
commonly used in the field of health
care information technology: interfacing, integration, and interoperability. Understanding these terms will
facilitate health-system pharmacists’
communication with information
technology professionals, vendors,
and government entities.
Definitions
Interfacing: A method of commu-
nication using a standard language
that allows different information systems from different vendors to share
information.
An interface can be either unidirectional (one-way) or bidirectional
(two-way). In the case of a unidirectional interface, information is sent
from one system to another, but there
is no mechanism to return that information to the originating system.
With a bidirectional interface, information is sent from one system to
another and vice versa. A pharmacyspecific example of a unidirectional
interface is the transfer of informa-
Rhonda McManus, Pharm.D., is Director, Clinical Education and
Development, CareFusion Pyxis Products, San Diego, CA. Eric C.
Nemec, Pharm.D., BCPS, is Clinical Assistant Professor, College of
Pharmacy, Western New England University, Springfield, MA. Darren
S. Ferer, B.S.Pharm., is Pharmacy Informatics Coordinator, Kaleida
Health, Buffalo, NY. Karl F. Gumpper, B.S.Pharm., BCPS, FASHP,
is Director, Section of Pharmacy Informatics and Technology, Pharmacy Practice Sections, American Society of Health-System Pharmacists, Bethesda, MD.
The following individuals served on the 2010–11 Section Advisory Group on Pharmacy Operations Automation: Gwen Volpe,
B.S.Pharm. (Chair), Barbara Giacomelli, Pharm.D., M.B.A. (ViceChair), Leslie Brookins, B.S.Pharm., M.S., Ron Burnette, B.S.Pharm.,
M.B.A., PMP, Richard Capps III, Pharm.D., Kavish Jay Choudhary,
Pharm.D., M.S., William Coffey, B.S.Pharm., D.D.S., Seth Aaron
Cohen, Pharm.D., Thomas W. Cooley, B.S.Pharm., Charles De la
Torre, B.S.Pharm., Doina Dumitru, Pharm.D., M.B.A., Darren S.
Ferer, B.S.Pharm., Christopher Fortier, Pharm.D., LeAnn Graham,
Pharm.D., Staci Hermann, Pharm.D., M.S., Jennifer J. Howard,
Pharm.D., Isha S. John, Pharm.D., Seth A. Kuiper, Pharm.D.,
Louis Levenson, B.S.Pharm., Robert Locke, B.S.Pharm., Mick
Lowry, B.S.Pharm., Silvia Maranian, B.S.Pharm., Rhonda McManus,
Pharm.D., Eric C. Nemec, Pharm.D., BCPS, Nancy A. Nickman, Ph.D.,
tion from the pharmacy system to
a laboratory system, but there is no
return interface to send information
on laboratory test results to the pharmacy system.
A pharmacy-specific example
of a bidirectional interface is the
pharmacy information system (PIS)
transmitting medication order information to automated dispensing cabinets or robotic devices
and receiving billing information
from those systems. Other examples
within the health care industry include the synchronization of data
between a computer and a handheld
Beth Prier, Pharm.D., M.S., Brad Rognrud, B.S.Pharm., M.S., Kevin
Scheckelhoff, B.S.Pharm., M.B.A., Ronald Schneider, B.S.Pharm.,
Steven Silverstein, Pharm.D., BCPS, Chad S. Stashek, Pharm.D., M.S.,
David Tjhio, Pharm.D., M.S., Dennis A. Tribble, Pharm.D., Thuy Vo,
Pharm.D., Robynn Wolfschlag, B.S.Pharm., M.B.A., Aaron Speak,
Pharm.D., and Christopher J. Urbanski, B.S.Pharm., M.S.
The following individuals served on the 2011–12 Section of Pharmacy Informatics and Technology Executive Committee: Allen Flynn,
Pharm.D., CPHIMS, CHS (Chair), Kevin Marvin, B.S.Pharm., M.S.,
FASHP, FHIMSS (Chair-elect), Christopher J. Urbanski, B.S.Pharm.,
M.S. (Immediate Past Chair), Leslie R. Mackowiak, B.S.Pharm., M.S.,
Sylvia M. Thomley, Pharm.D., M.S., Gwen Volpe, B.S.Pharm, and
Michael D. Sanborn, B.S.Pharm., M.S., FASHP (Board Liaison).
Address correspondence to Dr. Gumpper at the Section of Pharmacy Informatics and Technology, American Society of HealthSystem Pharmacists, 7272 Wisconsin Avenue, Bethesda, MD 20814
([email protected]).
The authors have declared no potential conflicts of interest.
Copyright © 2012, American Society of Health-System Pharmacists, Inc. All rights reserved. 1079-2082/12/0701-1163$06.00.
DOI 10.2146/ajhp110612
Am J Health-Syst Pharm—Vol 69 Jul 1, 2012
1163
ASHP Reports Informatics terms
device (bidirectional interface) and
the submission of an order online
but the receipt of order confirmation
via standard post or other hard-copy
formats (unidirectional interface).
Integration: The seamless interaction of various applications from a
single vendor that forms a larger and
more complex system.
An integrated system occurs when
a commonly defined data pool supports and is generated by different
workflows, enabling all components
to work as a single synchronous system. To the end user, all workflows
within an integrated system appear
seamless, allowing them to gain access to all information through one
process. User activity is completed
in one step, with no delays related to
translation or copying. For example,
in an integrated system, a pharmacist
reviewing orders entered into the
computerized prescriber-order-entry
system may access a prescription
from the PIS, view pertinent laboratory results without logging into the
laboratory information system, or
review drug administration data in
the electronic medication administration record (eMAR) without a
separate login to the eMAR.
Pharmacy examples of integrated
systems include Cerner (Cerner
Corporation, Kansas City, MO), Epic
(Epic Systems Corporation, Verona,
WI), and MEDITECH (Medical
Information Technology, Inc., Westwood, MA). Other examples within
the health care field include enterprise software packages from PeopleSoft (Oracle Corporation, Redwood
Shores, CA) and SAP (SAP Americas,
Newtown Square, PA).
Interoperability: The ability of
two systems to exchange data in a
meaningful fashion without human
prompting. Interoperability requires
cooperation between two or more
systems on two levels: syntactic and
semantic.
Syntactic interoperability: Agreement on how messages between
systems are constructed. Such agree1164
ment is achieved when standard
messages (e.g., Health Level 7 [HL7]
messages) can be used to enable information transfer between systems;
this implies that the standard message set is sufficiently well-known
and consistent that any receiving
system can receive and properly parse
the information based on a common
understanding of message structure.
HL7 admission, discharge, and transfer (ADT) processing has achieved
this level of commonality; virtually
any system that handles HL7 messaging can handle ADT messages
without modification. This level of
standardization has not yet been
achieved with HL7 order-processing
messages.1
Semantic interoperability: Agreement on the meaning of the message
content. Such agreement is achieved
when the content of a standard message is sufficiently standardized so
that the meaning of the message is
clear. The use of standard dictionaries such as the Systemized Nomenclature of Medicine (SNOMED) and
RxNorm (both available through the
National Library of Medicine) is required to ensure that the meaning of
information is unambiguous.1
Interoperability requires that
systems are individual, separate, and
distinct but are able to exchange
information in a meaningful fashion. Interoperability may be accomplished by interfaces, by altering the
data that support various workflows,
or by providing a mediating device
to facilitate data coordination; thus,
interoperability failures occur within
“fully integrated” systems only when
that integration is, in fact, incomplete
or when some functions within the
system remain isolated from the integrated whole. On the other hand,
organizations that purchase software
from multiple vendors require interoperability in order to achieve the
meaningful exchange of information.
Health information exchange (HIE)
can be defined as the electronic
movement of health-related infor-
Am J Health-Syst Pharm—Vol 69 Jul 1, 2012
mation securely among organizations to facilitate the aggregation of
data into a longitudinal electronic
health care record. Successful HIE requires the ability to promote the interoperability of disparate systems to
allow providers to access all clinical
data.2 HIE expands on information
interoperability and involves multidirectional flows of information
among providers (hospitals, physicians, clinics, laboratories) and other
sources of administrative or clinical
information provided by consumers,
health plans, employers, and local,
state, or national organizations.
One example of pharmacy system
interoperability might involve a retail
pharmacy receiving electronic prescriptions from various prescribing
systems (e.g., hospital based, private
practice based) and transmitting information (e.g., dosing changes, refill
requests) back to those systems.
Another, non-pharmacy-specific
example of interoperability is provided by modern electronic banking–
finance systems, which allow direct deposits, online bill payments,
electronic transfers, and access to
automated teller machines anywhere
in the world—even those operated
by banking institutions at which the
user does not hold an account.
Discussion
Pharmacists are hearing the terms
integration, interfacing, and interoperability more frequently as hospitals
work toward meeting the “meaningful use” standards of the Health Information Technology for Economic
and Clinical Health (HITECH)
legislation.3 In the ideal situation, all
hospital information systems would
meet the needs of the departments
using them, have no downtime, and
allow for the easy communication of
data between systems and also to any
other health care provider or entity;
currently, however, this frequently
is not the case, as each department
has specific requirements, forcing
hospitals to choose between using
ASHP Reports Informatics terms
an integrated information system and purchasing software from multiple vendors.4 The HITECH legislation,
with its standards on the electronic reporting of data
and incorporation of HIE elements into the practice of
health care, requires that pharmacists be more cognizant of vendor terminology, especially as it relates to the
medication-use process.5 Being aware of the differences
between the specific terms discussed here while implementing new technology will provide more realistic
expectations of system capabilities, user options, and
support needs.6
References
1. Tribble DA. Interfaces 101: unidirectional and bidirectional information exchange. Am J Health-Syst Pharm. 2009; 66:214-23.
2. Healthcare Information and Management Systems Society. Topic
series: defining health information exchange. www.himss.org/
content/files/2009DefiningHIE.pdf (accessed 2011 May 31).
3. Blumenthal D, Tavenner M. The “meaningful use” regulation for
electronic health records. N Engl J Med. 2010; 363:501-4.
4. ibex Healthdata Systems, Inc. Best of breed vs. integrated systems
(November 2009). www.thoccer.com/whitepaperBESTOF_
BREED.pdf (accessed 2011 Jan 19).
5. Healthcare Information and Management Systems Society. HIE
implications in meaningful use stage 1 requirements (March
2010). www.himss.org/content/files/HIE_MU_Matrix033110.pdf
(accessed 2011 May 31).
6. Hermann SA. Best-of-breed versus integrated systems. Am J
Health-Syst Pharm. 2010; 67:1406-10.
Am J Health-Syst Pharm—Vol 69 Jul 1, 2012
1165