Interoperability in healthcare refers to the seamless and secure exchange of electronic health information between authorized users of such information. In other words, it is as much about sharing, as it is about protecting the privacy of patient health data. Healthcare interoperability is complicated by the sheer number of players that might be involved in any given health-related transaction (e.g., providers, payers, consumers), all of whom may be utilizing disparate and potentially inconsistent systems and structures of data. Accordingly, to facilitate the seamless transfer, exchange, and protection of personal health information, it must occur at four distinct “levels” that have been defined by the Health Information and Management Systems Society:
Foundational –which addresses inter-connectivity requirements within systems themselves to communicate data between/among one another.
Structural – which defines format, syntax, and organization of data necessary for sharing and exchange.
Semantic – which defines underlying models for data, including standardized codes such as those established by HIPAA, enabling shared understanding between users of disparate systems.
“New” Organizational – which is akin to “information governance” (framing the overarching policy for handling all information received or generated by an organization).
In late 2015, the Office of the National Coordinator for Health Information Technology (ONC) released what it refers to as a roadmap for enabling individuals and organizations to securely share health information with any provider—with the goal of supporting “a wide range of health and wellness functions, which will ultimately benefit patients and their families.” In so doing, ONC essentially called on all health IT stakeholders to develop policies and technical approaches to help achieve the ability to share information seamlessly. As of March 2019, the federal government has invested $36 billion in promoting the digitization of health information. In 2017 alone, hospitals spent nearly $25 billion globally on electronic health records, and such spending is projected to increase to $33 billion by 2023.
Yet according to the Centers for Disease Control and Prevention, the percentage of office-based physicians using a certified EHR system is not even 80 percent.And despite all the spending, a 2018 survey of nearly 600 primary care physicians (PCPs) conducted by The Harris Poll on behalf of Stanford Medicine indicates providers have yet to see significant value in their investments of money, time, and effort in adopting and using EHRs.