Interoperability: secure network connections

Interview with Andreas Grode, Head of Innovation, gematik - Society for Telematics Applications of Health Cards


Computers do not just need a common language to communicate with each other. Their conversations also need to be secure when they transfer medical data for example. Yet there are still many different systems by various providers in the health care system that are not able to properly communicate with each other. The solution is called interoperability.
Image: Smiling man with short dark hair, tie and suite - Andreas Grode; Copyright: gematik

Andreas Grode; ©gematik

In this interview with, Andreas Grode explains interoperability, how it can benefit the health care sector and patient care and how it can be implemented in Germany and the European Union.

Mr. Grode, the term 'interoperability' is currently all over the media. What does this term actually mean?

Andreas Grode: Interoperability is the ability of different systems, devices and programs to work together to efficiently exchange information. There are many levels to be considered in health care settings when it comes to electronic data exchange for interoperability to actually work. All stakeholders need an identification for authorized data access for example. The identification mechanisms and role assignments need to harmonize. Data transmission has to occur based on the same standards and in a confidential and unaltered manner. In addition, all contents need to be structured and if need be even encoded in an interoperable manner to where misinterpretations are impossible; legal and contractual principles are also added to this.

What significance does the connection of devices and systems have in this context for the health care sector?

Grode: Medicine has already utilized integrated systems for quite some time, in the case of imaging methods or to generate a diagnosis for instance. Think about personal health records in medical group practices or the medical records in hospitals or the transfer of laboratory data as examples. However, the new way is interconnection, meaning across sectors and borders. The legislator has enacted an amendment to the SGB V (German Social Code) to implement this securely and comprehensively. This integration also means a different way of handling medical data of insured persons since the many types of information that are filed at different places can be consolidated in the future if needed.

Image: Plugs at the back of a computer; Copyright:

Interoperability in medicine is not that easy: network connectors and USB plugs make it rather easy to connect computers and devices at home nowadays. The issue is much more complex in health care since there are no standards; ©

What are the advantages in terms of patient care?

Grode: The daily interaction with connected systems allows patients to receive effective support using technological aids to maintain their health or assist in therapy. This is also an issue of integrating mobile systems into the health care process. The "Chances and Risks of Mobile Health Apps - CHARISMHA" study by the German Federal Ministry of Health illustrates what is presently feasible. Having said that, all health care information, whether it is in the health care system or in the hands of patients requires a reliable, verifiable network that operates in a secure and interoperable manner. And one that ensures that only the "right" stakeholders are able to use the infrastructure and data, so misuse is impossible.

In your opinion, is there something that speaks against the implementation of universal and extensive interoperability, for instance in terms of data protection and security?

Grode: If you want to enable and ensure interoperability, you need to first be clear on what this means and whether "global" or "general" interoperability is actually feasible. One example is human communication through language. In this case, "global" interoperability would mean everyone on Earth is able to talk with each other because they either speak the same language or the different languages are spoken by all. Both settings are unrealistic. A similarly unfavorable scenario is conceivable if translated into Germany’s health care system: the introduction of electronic health records that are offered by several providers and that do not interoperate with each other. Do users (physicians, pharmacists, patients) want a separate solution for each provider – depending on the treatment location or the patient’s choice? Or does a standard solution make more sense where all providers jointly implement the data exchange, contents, encoding etc. in an interoperable way? And this is precisely the challenge in an environment where technological and technical changes take place at breakneck speed, especially in the health care sector. Data protection and information security are not obstacles in this case; they actually enable meaningful storage and secure the transfer of confidential, medical information.

How can health care policy and industry deciders as well as health care representatives handle occurring obstacles?

Grode: There will not be a panacea for every obstacle you are going to encounter. Yet as children of the information age, we are able to learn from the past. Our complex health care system does not constantly require new standards and norms. This is not how we achieve interoperability that transcends national borders. However, agreeing on common standards and adapting the different systems, roles and organizations all the way to technical solutions allows us to prepare in facing potential obstacles. After all, the legislator has already indicated the direction we need to move in.
Image: Screens with X-ray images; Copyright:

But then, data exchange in medicine is much more complex than at home. Imaging data in different formats and practice and hospital information systems from different manufactures are but one example; ©

What significance does interoperability have in Germany?

Grode: In the land of engineers, interoperability, that being the successful operation of products and their components, is still a quality indicator. The benefit of interoperability originated with the industrialization and standardization at the end of the 19th century; in Germany with the foundation of DIN, the utilization of DIN standards and their subsequent use in everyday life – often unnoticed. The objective of standardization and therefore interoperability was and remains to enable the same functionality at lower costs in a market with several manufacturers. Having said that, interoperability is not an end in itself. However, its importance is paramount. Especially in the eHealth sector, where sensitive and often vitally important medical data is being transferred, momentous mistakes must never be made. Interoperability ensures that information is transferred in an undistorted, unchanged and unambiguous way.

What projects to implement interoperability are currently taking place in Germany?

Grode: Currently, building the German health telematics infrastructure, that being the national network to transfer medical data, is essential. In this country, the setup and operation of this network are regulated by law and managed by gematik. This also includes the safeguarding of interoperability. Currently this takes place in several steps and will blaze a trail for further applications in the future that will subsequently utilize the telematics infrastructure as a secure network. This provides a non-proprietary and standard platform that can be used for secure information exchange in health care and beyond. Early interoperable applications are a part of this from the get-go and are gradually being supplemented by others. In addition, the eHealth Law also stipulates the creation of an electronic interoperability register. It is also provided by gematik and is designed to contain important information on the standards, profiles and specifications used in Germany to avoid additional developments pertaining to already existing solutions for example.

Are there similar projects at the EU level?

Grode: So far, various small and large projects on the cross-border exchange of patient data have been tested at the EU level. With the EU programme “Connecting Europe Facility“ national eHealth systems will now be interconnected Europe wide. Germany is also a participant. Activities are expected to start in 2017. We should be excited to see what the future brings.

Image: Man with glasses and beard - Timo Roth; Copyright: B. Frommann

© B. Frommann

The interview was conducted by Timo Roth and translated from German by Elena O'Meara.