Healthcare interoperability is the ability of different information technology systems to communicate, exchange, and use data. This process is complex because health records contain vast amounts of sensitive, varied, and unstructured information that must be moved securely between disparate organizations. Achieving seamless data flow is a fundamental goal in modern healthcare delivery.
The successful exchange of electronic health information (EHI) supports improvements in patient safety and the overall quality of care. Immediate access to a patient’s complete medical history allows providers to make informed treatment decisions, avoiding redundant tests or harmful drug interactions. Efficient data sharing also streamlines administrative processes, increasing efficiency across the health system. Improving interoperability requires standardizing data, creating transport networks, and establishing policies that mandate cooperation.
Establishing Foundational Data Standards
Effective data exchange requires that all systems speak the same “language,” meaning the format and terminology must be standardized. Historically, Health Level Seven Version 2 (HL7 v2) was widely used, but it required extensive custom coding for each unique connection, creating complexity and high maintenance costs. A modern solution, Fast Healthcare Interoperability Resources (FHIR), is designed to simplify data exchange.
FHIR uses a modular design where health data is broken down into small units called “resources,” such as a Patient or a Medication. This resource-based architecture is more flexible and easier to implement than older standards because it leverages common web-based technologies, including RESTful Application Programming Interfaces (APIs). Adopting familiar web standards makes it easier for developers to build applications that interact with health systems, accelerating interoperability.
Standardized formats alone are insufficient; the clinical meaning of the data must also be consistent across systems. This consistency is achieved through standardized terminologies like Systematized Nomenclature of Medicine—Clinical Terms (SNOMED CT) and Logical Observation Identifiers Names and Codes (LOINC). SNOMED CT provides codes for clinical concepts, including diagnoses and procedures. LOINC is the standard for identifying and coding laboratory tests and clinical observations. These terminologies work together to ensure that the clinical interpretation of health information remains intact during movement.
Creating Secure Data Exchange Networks
Moving standardized data requires secure, established pathways, often provided by exchange networks. Health Information Exchanges (HIEs) traditionally functioned at a state or regional level, allowing local providers to share patient records. While successful locally, these regional networks often operate independently, creating silos that prevent seamless sharing across state lines or between different vendor systems.
To address this challenge and create a unified national data highway, the Trusted Exchange Framework and Common Agreement (TEFCA) was established. TEFCA provides a common set of rules and technical requirements for health information sharing that participating networks must follow. The framework operates as a “network of networks,” connecting disparate systems under a single governance structure.
The backbone of this national system is composed of Qualified Health Information Networks (QHINs). Organizations that become QHINs agree to the Common Agreement, which mandates how they must securely exchange data with other QHINs. This structure allows a healthcare provider connected to one QHIN to securely exchange information with any participant connected to any other QHIN across the country, significantly expanding data exchange reach.
The increasing adoption of secure Application Programming Interfaces (APIs) facilitates real-time data flow, crucial for immediate care decisions. Unlike older methods involving batch transfers, APIs enable the precise, on-demand retrieval of specific data elements, such as a patient’s latest lab result. This mechanism supports a dynamic and responsive exchange, ensuring the latest data is available when and where it is needed for treatment.
Regulatory Drivers and Mandates
Regulatory action has compelled healthcare organizations to adopt interoperability standards and participate in data exchange. The 21st Century Cures Act, signed into law in 2016, included provisions aimed at improving the flow of electronic health information. This legislation shifted the focus from merely digitizing health records to ensuring they could be easily and securely shared.
A central component of this regulatory push is the Information Blocking Rule, which prohibits practices that unreasonably inhibit the access, exchange, or use of electronic health information (EHI). Information blocking applies broadly to healthcare providers, certified health IT developers, and health information networks. This rule provides the enforcement mechanism necessary to ensure organizations invest in the technology and processes required for sharing data.
The rule includes exceptions to permit withholding EHI in limited circumstances, such as to prevent patient harm or protect privacy as required by law. Outside of these exceptions, providers and vendors who engage in information blocking face sanctions, including potential financial penalties. This mandate has accelerated the adoption of modern standards, like FHIR, since certified Electronic Health Record (EHR) systems must utilize these technologies to comply.
Empowering Patient Data Access
A direct benefit of improved interoperability is the increased control and access patients have over their own health information. Modern standards allow patients to move beyond relying solely on patient portals or paper copies. The FHIR standard mandates the use of specific APIs that certified EHR vendors must expose, allowing patients to connect third-party applications.
This technical capability allows a patient to use a smartphone or computer application to pull health data, such as medications or lab results, directly from their provider’s EHR system. The patient uses existing patient portal credentials to authorize the third-party app, like a personal health record manager, to securely retrieve and consolidate their data. This process is known as consumer-mediated exchange.
Aggregating information from multiple providers into a single application empowers individuals to coordinate their own care more effectively. A patient seeing a new specialist can seamlessly share their consolidated medical history without relying on manual processes or faxed documents. This outcome demonstrates the practical result of technical and regulatory investments made in creating a connected health ecosystem.