Interoperability in healthcare refers to the ability of disparate health IT systems, devices, and applications to make patients’ health data complete and accessible at the point of care. Gaps in data flow between clinical settings and public health agencies can lead to poorer patient outcomes and higher healthcare costs.
The number of people living with multiple chronic conditions in the U.S. continues to rise. According to the CDC, 90% of the annual $4.1 trillion healthcare expenditure is attributed to treating these diseases. As more patients require coordinated care, access to complete and accurate health data across different providers and systems becomes essential for effectively managing complex chronic conditions.
Keeping this in mind, we will explore the key aspects of interoperability in healthcare, including its benefits, challenges, current standards, and government policies in this detailed guide.
- A primary goal of healthcare interoperability is to enable clinicians to access complete and accurate patient records at the point of care
- Effective interoperability requires breaking down barriers at organizational, departmental, system, and national levels
- AI technologies play a crucial role in enhancing semantic interoperability by converting unstructured data into standardized formats
- Government policies aim to promote interoperability and ensure that patients and providers can access necessary health information
- Ongoing collaboration among providers, payers, and policymakers is necessary to bridge existing gaps in healthcare data sharing
According to the Office of the National Coordinator for health IT (ONC), significant progress has been made in interoperability in recent years. The percentage of hospitals routinely engaging in all four domains of interoperable exchange has increased from 46% in 2018 to 70% in 2023.
However, despite this progress, challenges of interoperability in healthcare persist. While many hospitals now have access to patient data from external providers, less than 50% are successfully incorporating this data into individual patient records. This indicates that although the flow of health information has improved, significant gaps remain in building a fully integrated healthcare ecosystem.
Let’s explore some of the key EHR interoperability challenges healthcare providers face today:
Financial Constraints
Healthcare organizations often face budget constraints that can hinder their ability to invest in interoperable systems. The costs associated with upgrading legacy systems, integrating new technologies, and ensuring data security can be significant.
Resistance To Data Sharing
Despite the push for greater interoperability, some healthcare providers are hesitant to share patient data due to concerns about privacy, security, and potential financial implications. According to research from the ONC, 48% of hospitals report one-sided data-sharing relationships, where they share information but do not receive data from others.
Lack of Standardization
Interoperability standards like HL7 and FHIR are essential for facilitating data sharing through APIs. However, many healthcare providers still rely on customized EHR systems that are not fully compatible with these standards. This lack of standardization complicates data exchange between different providers.
Technical Challenges
One of the main obstacles to interoperability is the use of diverse EHR systems, which are often not compatible with one another. This can result in data silos, duplicated records, and fragmented patient information. Additionally, organizations with older legacy systems face the added burden of upgrading their technology, which can be both time-consuming and costly.
Data Security Concerns
Interoperable systems enhance patient care by making data more accessible. However, they can also introduce new security risks. The sensitive nature of patient information makes it a prime target for cyberattacks, and the increased connectivity of healthcare systems without adequate security measures can create new vulnerabilities.
EHR interoperability improves patient care by enabling seamless data sharing and access. This eliminates redundant processes, optimizes workflows, and ensures that the right information is available to the right people at the right time.
As Amy Waldron, Global Director of Health Plan Strategy & Solutions at Google Cloud, explains the importance of healthcare interoperability in a blog post:
“Healthcare organizations fully embracing data interoperability can lead the entire ecosystem forward. The computing power now available to identify trends and patterns in data makes it possible for plans, providers, researchers, and public health officials to collaborate by securely sharing data so they can respond more quickly and accurately to health events at both individual and community levels.”
Here are three core benefits that patients and providers associate with an interoperable EHR system:
Enhanced Care Coordination
The healthcare industry generates an estimated 30% of the world’s data volume, making effective coordination among healthcare professionals crucial. EHR interoperability facilitates efficient communication between primary care providers, specialists, and post-acute care teams. It also reduces duplicated tests, eliminates communication gaps, and ensures that patient data is readily available for more informed decision-making.
Improved Patient Outcomes
Interoperable EHR systems securely integrate electronic health data to promote patient-centered care. Healthcare providers can quickly access important details, such as allergies, medications, and past diagnoses, which leads to more accurate treatment plans and better overall patient outcomes.
Reduced Costs
EHR interoperability helps reduce costs by minimizing unnecessary administrative tasks. The Centers for Medicare & Medicaid Services (CMS) require healthcare systems to facilitate the seamless exchange of information among patients, providers, and payers. According to IBM, “A healthcare ecosystem where all stakeholders can easily exchange information enables payers and providers to better partner together to deliver high-quality and cost-effective care.”
Interoperability frameworks and standards define the data formats, protocols, and content needed for secure exchange of electronic health information between healthcare systems. They address data silos and establish a common method for sharing health information.
Some of the most widely adopted interoperability standards in the healthcare industry include:
Health Level Seven (HL7) Standard
Health Level Seven (HL7) is a globally recognized set of standards that governs the exchange, sharing, and retrieval of electronic health data across various systems. These standards specify the required codes, data types, and terminologies to ensure accurate and secure sharing of patient information.
Over the years, HL7 has introduced several versions of its messaging standards, with each version improving on the previous one to accommodate advancements in healthcare technology.
The World Health Organization (WHO) has also signed a project collaboration agreement with the HL7 organization to support the global adoption of these standards and promote their appropriate use.
Fast Healthcare Interoperability Resources (FHIR)
FHIR, developed by HL7, is a widely used standard designed to support the secure and efficient exchange of health information across different healthcare systems. It focuses on simplifying how health data is shared by organizing it into resources, such as patient records, medications, and clinical conditions.
With its API-based design, FHIR enhances interoperability and supports the development of modern healthcare applications. Major U.S. health systems such as Mayo Clinic, Kaiser Permanente, Intermountain Healthcare, and Cleveland Clinic have adopted FHIR to streamline data sharing and improve care coordination.
Certain government policies, including the CMS Interoperability and Patient Access Final Rule (CMS-9115-F), require healthcare organizations, especially those receiving Medicare or Medicaid payments, to adopt FHIR standards.
Integrating The Healthcare Enterprise (IHE)
IHE is a global initiative led by healthcare professionals and industry experts to enhance how health systems share and communicate data across different IT platforms. The IHE framework is built upon widely recognized healthcare standards, such as HL7 and DICOM, ensuring that systems from different vendors can communicate and work together seamlessly.
For a deeper understanding of how healthcare systems achieve seamless data exchange, check out our detailed guide on the levels of interoperability in healthcare.
The ONC has established several major policies to ensure efficient exchange of health data across systems and promote data interoperability in healthcare. Here are some key policies:
21st Century Cures Act
The 21st Century Cures Act is a legislative framework that prohibits information blocking and mandates secure exchange of patient information. The ONC’s Cures Act Final Rule, which further implements the provisions of the 21st Century Cures Act, sets specific requirements for healthcare organizations to adopt standardized APIs and participate in trusted exchanges of health information.
Trusted Exchange Framework And Common Agreement (TEFCA)
TEFCA is a data exchange framework established by the ONC to promote interoperability in healthcare. It provides a common set of rules and standards that healthcare organizations must follow to securely exchange electronic health information.
USCDI And USCDI+ For Public Health
The United States Core Data for Interoperability (USCDI) is an initiative led by the ONC to provide a standardized format for exchanging clinical and administrative data. This standard supports the exchange of information for various purposes, including treatment, payment, healthcare operations, and public health initiatives.
USCDI+ builds on this framework by extending the standard to address specific public health use cases, ensuring that certified health IT systems can effectively communicate and analyze relevant data.
ONC Health IT Certification Program
The ONC Health IT Certification Program is a voluntary program designed to ensure that EHRs and other health IT systems meet the national functionality, security, and interoperability standards. ONC collaborates with accredited certification bodies to evaluate and certify health IT products that demonstrate compliance with these standards.
Artificial intelligence (AI) is creating new ways to simplify and improve the exchange of information between different health systems. Here’s how AI is contributing to the future of healthcare interoperability:
Advancing Semantic Interoperability
AI plays a big role in enhancing semantic interoperability, which ensures that different systems not only exchange data but also understand the meaning behind it. As Scott Stuewe, President and CEO of DirectTrust, explains, AI can "create standardized clinical documentation from unstructured text," which helps systems speak the same language.
For example, hospitals can use AI to turn a faxed medical report into a standardized document to improve the accuracy and speed of data sharing.
Mapping And Transforming Data
AI algorithms can map and translate data from one format to another. According to a study published in the journal NEJM AI, an AI model called FHIR-GPT, developed by Northwestern Medicine investigators, uses large language models to convert clinical EHR data into FHIR. This is a huge step toward breaking down data silos and supporting large-scale healthcare research.
Moreover, AI can help address interoperability challenges in various other ways, such as through predictive analytics, machine learning (ML), natural language processing (NLP), and AI-powered IoT and wearables.
The healthcare industry generates vast amounts of data, but the value of this data is limited without effective interoperability. As National Coordinator for Health IT Micky Tripathi notes, "We have a lot of work to do to get that interoperability that's already there all the way down to the frontline and implemented fully."
Moving forward, it is crucial for healthcare organizations to adopt a unified approach to data sharing. This not only includes using the right technology but also fostering collaboration among providers, payers, and policymakers to address existing gaps in care.
By prioritizing these areas, healthcare organizations can break down silos, enhance care coordination, and fully realize the potential of interoperability.
