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Interoperability – Yesterday, Today, and Tomorrow

This Insights post is the first of our 3-part series on advancing interoperability. Jump to Part 2: Defragmenting Healthcare with FHIR, or to Part 3: Supporting Interoperability During A Pandemic.

Last month, I attended a health information exchange bonanza: the 5th annual Strategic Health Information Exchange Collaborative (SHIEC) conference and the 3rd annual Interoperability Forum, hosted by the Office of the National Coordinator for Health IT (ONC). These back-to-back meetings in Washington, D.C. provided a unique opportunity to ponder the past, present, and future state of interoperability.

While so many of the faces and topics were the same as in years past, there was something decidedly different about the energy and sense of optimism at both conferences. I come from the era of 2004’s Executive Order 13335, which called for a full-scale electronic update of our health system within a 10-year timeframe and created the ONC to oversee the transition. I lived through the fury of the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009 and the victories that came from “meaningful use” and the Electronic Health Record (EHR) certification program. Along the way, I watched the Interoperability Showcase at the annual HIMSS conference grow from a small concept, tucked far away from the rest of the exhibit floor, to a massive cornerstone of the event. Everyone wanted to show they could exchange data – but it seemed like so few really could. The presentations and discussions at last month’s conferences have made me believe that the community that has worked so hard to achieve interoperability may soon be able to realize its promises.

The 21st Century Cures Act has pulled into sharp focus what stakeholders need to accomplish to achieve interoperability. The Act calls for interoperable health IT that:

  • “enables the secure exchange of electronic health information without special effort on the part of the user;
  • [provides] complete access, exchange, and authorized use of electronic health information; and
  • [has] no information blocking.”

This next phase of interoperability demands that systems and policies are put into place to allow patients, providers, payers, and other stakeholders to efficiently access and use the health information they need to make decisions. The widespread availability of application programming interface (API) functionality within EHR systems, the rapid development of Fast Healthcare Interoperability Resources (FHIR®) implementation guides, and the increasingly clear importance of data standards and metadata are providing the fuel needed to push the pursuit of interoperability into a new era.

Doctor uses iPad to look up patient health data


"This next phase of interoperability demands that systems and policies are put into place to allow patients, providers, payers, and other stakeholders to efficiently access and use the health information they need to make decisions."

Those working in the field know there are still barriers that make achieving full interoperability a challenge. RTI has a long history of supporting interoperability efforts from advancing health information exchange to piloting consumer-mediated data exchange. Our work supporting early federal efforts like the Privacy and Security Solutions for Interoperable Health Information Exchange and the Health Information Security and Privacy Collaboration provides a perspective on the industry’s progress toward interoperability. We can also apply lessons learned to several specific areas where challenges remain. One example is patient matching. While many have suggested over the years that creating universal identifiers is one way to link patients across datasets and systems, our previous research describes the technical and legal challenges of this approach and offers alternatives for stakeholders to revisit in today’s landscape. Similarly, we can apply our previous work creating a governance structure for interstate data exchange to other efforts across the country that are advancing trusted exchange. We expect to carry those lessons forward as we provide support for The Sequoia Project, which is serving as the Recognized Coordinating Entity to administer the proposed Trusted Exchange Framework and Common Agreement (TEFCA).

The state of interoperability is rapidly evolving due to the regulatory environment and partnerships across the public and private sectors. As stakeholders continue to pilot the various technical requirements needed to integrate data, it is important to remind ourselves of how far we’ve come. I look forward to seeing greater progress in the near future and feel invigorated that we can overcome the remaining challenges in our way. Interoperability is built step-by-step, by a small and growing group of people dedicated to making it happen.

Learn more about our previous work supporting the necessary data standards, information exchange, and policies to advance interoperability. Please join us in our commitment to provide research and applaud the successes of our past, present, and future.

Disclaimer: This piece was written by Stephanie Rizk (Manager, Health IT Policy) to share perspectives on a topic of interest. Expression of opinions within are those of the author or authors.