The State of Interoperability in Healthcare: Progress and Remaining Challenges 

If you’re at all knowledgeable about the healthcare industry, you know that interoperability in healthcare is not just a technical challenge, but a human imperative. 

It doesn’t take much imagination to recognize the benefits of interoperability.  

When a patient comes into a hospital’s emergency department critically injured or unconscious, they may not be able to accurately communicate their medical history, allergies, chronic conditions, current medications, and other vital healthcare information about themselves.  

By leveraging data interoperability in healthcare, that patient’s information can be called up in the hospital’s electronic health records (EHR) system—even if the patient has never been to that specific hospital. 

It’s not an exaggeration to say that healthcare interoperability is life or death.  

In this article, we explore the immense potential of interoperability to improve healthcare and the significant hurdles we must overcome to achieve it. 

What Is Interoperability in Healthcare? 

First, let’s define what we mean by interoperability. Data interoperability in healthcare refers to the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged. 

Essentially, it’s about making sure that all parts of our complex healthcare system can talk to each other seamlessly. 

The Office of the National Coordinator for Health Information Technology (ONC) measures hospitals against four “domains” of interoperability: Send, Receive, Find, and Integrate.  

Send  

The hospital can push a digital summary of a patient’s care records to other healthcare providers or organizations using one of the following methods: 

1. Provider portals that allow outside organizations to view records in the hospital’s EHR system. 

2. Interface connections between EHR systems (for example, an HL7 interface).  

3. Login credentials that allow access to the hospital’s EHR.  

4. HISPs that enable messaging via DIRECT protocol. 

5. Regional, state, or local health information exchange organizations (HIE/HIO).  

6. EHR vendor-based networks that enable record location within the network (for example, Care Everywhere). 

7. EHR connections to national networks that enable record location across EHRs in different networks (for example, CommonWell, eHealth Exchange, Carequality). 

Receive 

The hospital can receive a summary of patient care records from other providers or organizations using one of the methods described above.  

Find  

Providers at the hospital can electronically query patients’ health information (for example, medications and outside encounters) from sources outside their organization or hospital system. 

Integrate  

The hospital’s EHR integrates a summary of patients’ care records received electronically from providers or sources outside the hospital’s system or organization without the need for manual entry. 

The ONC’s fifth metric—All Four Domains—measures whether the hospital engages in all four domains of interoperability (in other words, sends, receives, finds, and integrates information into their electronic health record. 

How Close Are We to True Interoperability? 

According to ONC Data Brief No. 71, released in May 2024, 70 percent of non-federal acute care hospitals engaged in all four domains of interoperable exchange in 2023.  

While that seems like fairly good news, routine engagement in all four domains did not increase between 2022 and 2023, after a steady rise since 2018.  

This plateau in interoperability may be due to a lack of resources. The brief reports that lower-resourced hospitals (in other words, small, rural, critical access, or independent providers) engaged less frequently in interoperable exchange than higher-resourced hospitals. 

There also seems to be a gap between acute-care hospitals and long-term post-acute care facilities. Only 16% of hospitals reported sending summary of care documents to most or all long-term and post-acute care providers, and 17% reported sending summary of care records to most or all behavioral health providers. Only 8% of long-term post-acute care providers sent information to hospitals, which was also true of behavioral health providers. 

The Benefits of Interoperability 

Achieving true interoperability can profoundly impact the future of healthcare quality, efficiency, and affordability. 

With access to complete patient histories, healthcare providers can make more informed decisions, reduce medical errors, and provide more personalized care. AI healthcare solutions promise to improve the speed, accuracy, and accessibility of patient information at the point of care. 

Data interoperability in healthcare streamlines workflows, reduces duplicate testing, and saves time and resources for both patients and providers. It also increases patient engagement; when patients have easy access to their health data, they become more engaged in their care and can make better health decisions. 

When it comes to advanced research, interoperable systems can facilitate large-scale data analysis, accelerating medical research and the development of new treatments.  

Finally, interoperability also helps reduce the cost of care. By eliminating redundancies and improving efficiency, interoperability has the potential to reduce healthcare costs significantly. 

Interoperability Challenges 

Although we’ve achieved higher levels of data interoperability in healthcare, we still face several significant challenges. 

Data Standardization 

Healthcare data comes in many formats, from structured electronic health records to unstructured doctor’s notes. Standardizing this data and ensuring systems can interpret it correctly is an imposing technical challenge. The fragmented US healthcare system and its multitude of providers and payers (who often use different systems themselves) further complicates this challenge. 

Adopting industry-wide standards like Fast Healthcare Interoperability Resources (FHIR) helps move the industry toward a shared language for exchanging healthcare data. The ONC has a list of standards and technologies to help overcome this challenge.  

Data Quality 

In addition to standardization, data quality presents a challenge. Low-quality data (such as extraneous data, unreliable samples, and missing and non-valid information) can impact the accuracy of summary of care records and other patient data.  

Statistical data analysis can improve data quality by identifying patterns, outliers, and irregularities. Likewise, AI and machine learning algorithms can detect anomalies, inconsistencies, or discrepancies in text and numerical data. 

Privacy and Security Concerns 

As we make data more accessible, we must also ensure it remains secure and private. This is especially crucial in healthcare, where data breaches can have severe consequences. Already, the healthcare industry has been targeted by multiple malicious breaches, ransomware attacks, and other cybersecurity threats. Interoperability initiatives must harden healthcare IT systems against these attacks, not make them more vulnerable. 

Any new custom healthcare software development should involve strong encryption methods, electronic document signatures, least-privilege access, and a defense strategy that leverages multiple security measures. In addition, security protocols should be regularly reviewed and updated to remain in compliance with data privacy regulations such as HIPAA, GDPR, PHIPA, and others. 

Legacy Systems 

Healthcare systems that have yet to achieve interoperability might be using older technology. Before secure data exchange is possible, they may require expensive upgrades to their EHRs and other systems and may not have the downtime or budget to make those upgrades. 

The ONC report shows that hospitals engaging in routine interoperable exchange are more likely to be larger, urban providers in a health system. These hospitals have deeper pockets than the smaller, rural, and independent hospitals lagging in interoperability. But until we can overcome this gap, full interoperability will continue to elude us. 

The Path Forward 

Interoperability in healthcare is not just about technology—it’s about people. It’s about ensuring that no matter where a patient receives care, their healthcare providers have the information to give them the best possible care. It’s about tracking disease outbreaks and preventing future pandemics. And ultimately, it’s about saving lives. 

The road is challenging, but the benefits of interoperability are worth the effort. By breaking down the walls that separate our health data, we can build a more connected, efficient, and effective healthcare system for all. 

If your organization needs help overcoming the roadblocks to interoperability, Taazaa may be able to help. We work with providers and innovators to build custom healthcare software solutions that improve the quality of care and make people’s lives better. Contact us today!