In the last few years, a lot of HealthIT energy has been devoted to achieving health information exchange (HIE), also called interoperability between electronic health records (EHRs). The energy has come from national legislation and funding, but implementation is being achieved by private sector initiatives and state-wide exchanges. Despite significant barriers to sharing patient medical data between institutions, today it seems like only a matter of time before Health IT infrastructure is interoperable.

The status of interoperability

Health information exchange is dependent on EHR adoption, which has expanded significantly since the meaningful use financial incentives were established in 2009. According to 2014 data, more than 80% of hospitals and half of office-based professionals have adopted EHRs and are meeting meaningful use standards.

While this digitization of health records is laying the necessary groundwork for HIE, we’re still pretty far from interoperability. Today, just half of hospitals can electronically search for patient information at sources beyond their organization’s health system, and doctors everywhere are frustrated by the barriers to sharing EHRs.

Successful interoperability has taken place through state-level initiatives, with all 50 states having some form of Health Information Exchange. These State HIEs were created in response to funding from the Office of the National Coordinator for Health IT (the ONC), which has invested over $547 million in 56 entities since 2010 (according to a TechTarget guide on EHR interoperability). While certain states have made impressive progress, substantial barriers to HIE still exist.

A 2013 ONC video highlights state efforts to develop and implement HIEs

The biggest barrier to achieving interoperability is the need for HIEs and other health care facilities to adopt and use a common data standard, regardless of the EHR or health IT system the use. As the ONC writes, “Electronic health information is also not sufficiently standardized to allow seamless interoperability, as it is still inconsistently expressed with vocabulary, structure, and format, thereby limiting the potential uses of the information to improve health and care.”

Explaining the details gets technical fast, but a “data standard” is basically a common architecture, coding, and semantic framework for the creation of electronic clinical documents. All certified EHR applications could support a standard called “C-CDA,” which was developed by the international non-profit HL7 and has gone through various versions. But C-CDA proved complicated to implement, and a new standard called “FHIR” is in the works, with impressive buy-in from Health IT industry leaders.

Check in next week for more about the future of Health Information Exchange


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