HLTH 6443 Module 5 Interoperability and Data Sharing Evaluation Example

Entered Once, Seen Where Needed: Evaluating Interoperability Options for a County Referral Platform, Its Clinics and Its Agencies

Student Name

American College of Education

HLTH6443: Systems, Policy, and Leadership in Health Informatics

Module 5 Assignment

Instructor Name

June 29, 2026

Introduction

The earlier modules found that the referral platform serving a composite western Michigan county works well for sending referrals but poorly for closing them, and that one reason is double entry. Clinic staff must leave their electronic health record to send a referral, and agency staff must leave their case management system to update it. Referral platforms commonly advertise systems integration, yet early adopters describe it as one of the harder functions to realize (Cartier et al., 2020). This paper evaluates four options for connecting the platform to the other systems its users depend on. It first sets out what interoperability means at different levels, then judges each option on benefit, cost, privacy and feasibility, and ends with a recommendation for the platform's second phase.

Levels of Interoperability

Interoperability is often described at four levels. At the foundational level, one system can transmit data to another. Structural interoperability ensures the data arrive in a format the receiving system can parse, field by field. Semantic interoperability ensures both systems understand the data the same way, through shared codes and definitions. Organizational interoperability covers the agreements, policies and workflows that let organizations actually use exchanged data. The county's platform can already send data; its problems lie at the semantic and organizational levels, where a food need in one system must mean the same thing in another and someone must be responsible for acting on it.

Relevant Standards

Health Level Seven's FHIR standard (Fast Healthcare Interoperability Resources) represents health data as discrete resources exchanged through web-based application programming interfaces, an approach designed to be easier to implement than earlier messaging standards (Bender & Sartipi, 2013). SMART on FHIR builds on it, allowing applications to launch inside different electronic health record systems and use the record's data through a common interface; its developers demonstrated prototypes with several commercial vendors (Mandel et al., 2016). For social needs data, national efforts have developed codes for screening questions, social risk findings and referral activities in standard terminologies, and for resource directories, open data specifications allow community programs to be described consistently across systems.

Option 1: A SMART on FHIR App in Clinic Records

The platform vendor offers an app that launches inside the health center's and hospital clinics' electronic health records. A clinician would open the patient's chart, launch the app, see the social needs screening answers already recorded in the chart and send a referral without retyping the family's name, address and phone number; referral status would appear back in the chart. The benefit is large for referring staff and for closing the loop from the clinic's side, and the vendor's license already includes the app. Costs fall mainly on the clinics' information technology teams, which must configure and test the connection, estimated at 120 hours per health system. Privacy is manageable, since data move under the consent recorded in the platform, though clinics must ensure only the minimum necessary information passes. Feasibility is good for the health center, whose record system supports such apps, and uncertain for the smaller hospital clinic.

Option 2: Status Exchange With Agency Systems

The second option connects the platform to the case management systems used by the largest agencies, so that accepting and closing a referral in the agency's own system updates the platform automatically. Six agencies handle nearly half of all referrals, including the two housing agencies that use the regional homeless management information system and a food bank network with its own intake software. The benefit is direct: double entry at the busiest agencies, the main cause of the broken loop, would largely disappear. The costs are higher, because each connection requires work by the agency's software vendor, the platform vendor and the county, estimated at $18,000 to $30,000 per connection, and agreements must define which statuses map to which. Privacy requires care, since housing data systems carry their own rules on sharing. Feasibility is mixed: two vendors have offered to build connections, and others have not responded.

Option 3: A Shared Resource Directory

The third option addresses a different kind of duplication. The county's 211 information line, the platform and several agencies each maintain their own lists of community programs, and Module 1 found that about a fifth of the platform's directory was out of date. Adopting an open resource directory specification would let 211 maintain one directory that feeds the platform and other systems. The benefit is fewer referrals to programs that have closed or changed, and less work for the platform's resource specialist. Costs are modest and privacy risk is low, since directories describe programs rather than people. Feasibility depends on 211's willingness to share its data, which it has indicated in principle.

Option 4: Batch Reporting to the Health Department

The fourth option is the simplest: a monthly de-identified file from the platform to the health department's data warehouse, coded with standard categories for social needs, so that referral data can be analyzed alongside other community health data. It improves semantic consistency and supports the county's community health assessment. It does not reduce double entry, so it does nothing to close the loop, but it is inexpensive and can be done within weeks under the data-use protocol set in Module 4.

Comparing the Options

On benefit for closing the loop, the agency status exchange ranks highest and the clinic app second; the directory and batch reporting help less directly. On cost, the directory and batch reporting are cheapest, the clinic app moderate and the agency exchange most expensive. On privacy, the directory is safest, and the others are manageable under the consent and protocols already in place. On feasibility, batch reporting and the clinic app at the health center can proceed quickly, the directory depends on 211 and the agency connections depend on outside vendors. Across all four, organizational interoperability, agreements about who does what with exchanged data, is the constraint more often than technology.

What Families Would Notice

Interoperability is usually discussed in terms of staff time, but families would feel its effects as well. When a clinic can send a referral from the chart, the visit ends with the referral already made rather than a promise to do it later. When an agency's own system updates the platform, the family's text message saying that help was arranged arrives on the day it happens, and the clinic can follow up at the next visit knowing what happened. When the directory is shared with 211, a family calling the helpline and a family referred by a nurse are sent to the same, current program. None of these changes requires families to do anything new, which matters for households already juggling several agencies. The evaluation therefore treats reduced delay and fewer dead-end referrals for families as a benefit alongside staff time saved.

Recommendation

The recommended sequence is to implement the clinic app at the health center and batch reporting in the first six months, pursue the shared directory with 211 in parallel and build status exchange with the two agencies whose vendors have agreed, starting with the food bank network, in the second half of the year. Each connection will be governed by a written agreement defining data elements, status mappings, responsibilities and review, approved by the governance committee. Success will be measured by the proportion of connected agencies' referrals that end with a recorded outcome, compared with agencies not yet connected.

Conclusion

Interoperability for this platform is less about sending data, which it already does, than about shared meaning and shared responsibility. Connecting the platform where staff already work, in clinic records and agency systems, attacks the double entry that keeps the loop open. Module 6 will set out the leadership plan for carrying this and the other recommendations into the platform's second phase.

References

Bender, D., & Sartipi, K. (2013). HL7 FHIR: An agile and RESTful approach to healthcare information exchange. In Proceedings of the 26th IEEE International Symposium on Computer-Based Medical Systems (pp. 326-331). IEEE. https://doi.org/10.1109/CBMS.2013.6627810

Cartier, Y., Fichtenberg, C., & Gottlieb, L. M. (2020). Implementing community resource referral technology: Facilitators and barriers described by early adopters. Health Affairs, 39(4), 662-669. https://doi.org/10.1377/hlthaff.2019.01588

Mandel, J. C., Kreda, D. A., Mandl, K. D., Kohane, I. S., & Ramoni, R. B. (2016). SMART on FHIR: A standards-based, interoperable apps platform for electronic health records. Journal of the American Medical Informatics Association, 23(5), 899-908. https://doi.org/10.1093/jamia/ocv189