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Background

Interoperability between systems allows for data exchange and utilization between systems making processes more efficient and effective.

The goal of the project was to recommend an interoperable standard to be used by the vendors creating a specialized application for the organization.

This application should be able to maintain communication with the systems in place that utilize SNOMED-CT and HL7 and other cancer hospitals that utilize HL7v2.

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Approach

Evaluation Criteria

We adopted some of the criteria for evaluation from eHealth Ontario 2013. Including:

Interoperability, implementation costs, governance structure, licensing costs, maintenance costs, implementation support, conformance testing, proven stability, adaptable and customizable

Additional criteria included to reflect the organization’s values and business requirements:

Usability, clinical standard, language, updates, privacy and security, multiple paradigms, flexibility and ease of data retrieval for analysis

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Approach...

Scoring
A 3-point scale was used.
Possible outcomes and their scores were clearly defined.
Pass 3-points, Acceptable 2-points, Fail 0-points.
Any unknown information about a standard was considered a fail-0 points.

EVALUATION CATEGORY	SUCCESS CRITERIA	SNOMED-CT	HL7V2	HL7 FHIR	ICD 10-CA
Different languages	PASS: The standard has codes for French and English FAIL: The standard only has codes for English terms only	3-Available in different languages	2-content is language neutral but specifications in English, other languages not maintained	2-content is language neutral but specifications in English, other languages not maintained	3-available in a variety of languages

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Approach��Prioritization: more than one criterion was used to comprehensively evaluate a factor that we considered important. Each of the criteria was scored the same, but altogether these factors had a greater score.

Category	Specific Criteria included	Rationale
Interoperability	Interoperability Flexibility (more than one computer language)	The application will be added to a system in place (EPIC EHR) and the data will be shared with other Cancer Hospitals in Ontario therefore, interoperability of the standard with EPIC and other systems is of paramount importance
Low Cost	Procurement costs Standard maintenance Implementation costs Adaptability and customization Add-ons during implementation	The organization is heavily financially restricted therefore procurement and maintenance costs are important as this will determine whether the organization can procure and maintain the standard
Customizable or comprehensive standards	Customizable standards Reliable standards Information is easily retrievable	Cancer departments use codes that are highly specialized therefore the standard must either be comprehensive or customizable and provide reliable data
Stability	Proven stability Conformance testing	The organization values stability, and has a low risk tolerance, therefore stable standards that have been in use for some time will be given priority over the newer standards that have not been tested before

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Approach......

The standards evaluated
Two messaging standards: HL7 v2 and HL7 FHIR
Two terminology standards: SNOMED CT and ICD 10 CA
The four standards that were selected for evaluation because:
They are widely used in healthcare in Canada
They have versions that have been customized to the local context
Are readily available and have been in use for a while.

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Recommendations

Based on our criteria in appendix 1, two standards, HL7 FHIR and SNOMED CT scored the highest results. Therefore, our recommended standards for use are HL7 FHIR and SNOMED CT. HL7 FHIR will be smart, safe, and fast way of healthcare data exchange for the cancer management app. Another important thing to consider is the collaboration and interoperability of the two standards HL7 FHIR and SNOMED-CT. This will help in fostering seamless data exchange and data interoperability anywhere and anytime when required. SNOMED CT provides a comprehensive data standard that easily maps to HL7 FHIR. The goal of choosing HL7 FHIR and SNOMED CT as standard for this application is to enhance the exchange and transfer of data in the application in a reliable and efficient way. Furthermore, many companies continue to make health applications using HL7 FHIR standards ensuring that it will remain relevant for future use.

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Evaluation Results

	SNOMED CT	ICD 10	HL7v2	HL7 FHIR
Evaluation Score	52/72 (72.2%)	47/72 (65.3%)	26/72 (36.1%)	56/72 (77.8%)
Standards recommended

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Recommendations

Two standards, HL7 FHIR and SNOMED CT scored the highest results.
Therefore, our recommended standards for use are HL7 FHIR as the messaging standard and SNOMED CT.
HL7 FHIR will be smart, safe, and fast way of healthcare data exchange for the cancer management app.
The collaboration and interoperability of the two standards HL7 FHIR and SNOMED-CT.
This will help in fostering seamless data exchange and data interoperability anywhere and anytime when required.
SNOMED CT provides a comprehensive data standard that easily maps to HL7 FHIR. The goal of choosing HL7 FHIR and SNOMED CT as standard for this application is to enhance the exchange and transfer of data in the application in a reliable and efficient way.
Many companies continue to make health applications using HL7 FHIR standards ensuring that it will remain relevant for future use.

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Rationale for recommendations

HL7 FHIR
Supports Multiple Data Paradigms And Architecture
Versioning
Utilizes Modern Security Standards
Understood By Developers
Information Easily Retrievable

SNOMED- CT

Capture Details
Presents Data In Multiple Levels Of Granularity
Comprehensive Clinical Database
Interoperable With Other Standards
Updated Frequently
Easy To Use

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Benefits

Low costs

Higher efficiency

Productivity

Patient Experience

Trustworthiness & credibility

Stability

Data security

Accuracy & Reliability

Usability, Processability & Understandability

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Risks

Multiple stakeholder involvement

Complexity of standardization

Adaptability & Customization issues

Maintenance

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Conclusion

Putting the business plan into action will create a cancer management system that delivers person-centered, safe, and effective services in an efficient, equitable and timely manner.
The ongoing priority is to help patients and caregivers move easily through the system.
This application will continue to improve communications between patients and their healthcare professionals, and among the various members of the care team.
This plan will help to translate knowledge and evidence into policy and program design recommendations and decisions across this cancer institute.