Dr. John Svirbely's blog post - In Healthcare, Interoperability is Just the Start
Dr. John Svirbely, MD

In Healthcare,

Interoperability is Just the Start

By Dr. John Svirbely, MD

Read Time: 3 Minutes

While interoperability has solved one problem by providing access to a large amount of medical data, there is now the problem of just what to do with it. Before discussing the solution to this problem, let us digress and talk about a juice box.

The simple juice box is seen everywhere, especially around children. Despite its outward simplicity, it is actually quite sophisticated. Its wall is made of multiple thin layers of paper, plastic, and aluminum foil, each with a specific function. These layers are needed to fulfill all of the requirements for economically delivering a spoilable liquid so that it is safe and free of contamination. It is an essential part of the journey from fruit to mouth.

Raw data is like fruit in that it may have problems and can even be dangerous. It is only after sorting and processing that it can be used to solve clinical problems and to become relevant for patient care. Like juice it must be delivered to its consumers safely, securely, and economically in a form that they can use.

These desirable features can be provided through the use of multiple layers provided by different types of open-standard software. These software standard layers – so called wrappers – each provide a specific function. These layers can provide:


data automation for cleaning and organizing it,


data contextualization, converting it into information,


orchestrating the use of this information in the clinical workflow, turning it into usable knowledge.

By that point the data has true value since it can be used for intelligent automation. This entire process is graphically represented by the following diagram.

The first layer is provided by FHIR, which provides a common data schema and associates appropriate medical resources. The second layer provided by standards such as CDS Hooks and Smart on FIHR can take this data and put it into a clinical context. It can identify what data is needed and why.

Once that data has been processed, it can then be used for decision support in a coordinated fashion. This orchestration can be achieved using process modeling and notation standards. While complete automation is possible, this can be impractical in dynamic and uncontrolled clinical settings. Rather, orchestrating the interaction between data and software while under the supervision of the clinician is more likely to be successful.

By providing a seamless solution this approach can improve patient care while reducing cognitive burden on clinicians and reduce errors.

Trisotech offers such healthcare orchestration by leveraging these open standards using its Healthcare Feature SET (HFS).

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