Interoperability: Promise and Progress 

Interoperability(1)For healthcare providers and their patients, interoperability holds the promise to substantially improve quality and reduce costs, while enabling coordination of care and engagement of patients with their caregivers. As ONC’s annual Interoperability Forum gets underway, it’s important to focus not just on where we want to be, but on how far we’ve come. 

EHRA members are strong proponents of health information exchange; our members have supported hundreds of thousands of providers in their effort to exchange electronic health information through the development of interoperability modules in their solutions, and participation in industry frameworks such as the eHealth Exchange, CommonWell Health Alliance, and Carequality. 

In 2017 EHRA published Interoperability Success Stories, real-world examples of interoperability benefiting patients and providers. Positive impacts of interoperability in the hospital, health system, and other use cases collected by EHRA members included: 

  • Reduction in duplicate tests
  • Up-to-date clinical information
  • Improved care coordination
  • Access to a patient’s immunization records
  • ED visit prevention
  • Aggregated data
  • Providing more time with patients
  • Millions of dollars in shared savings
  • More accurate documentation
  • Less faxing
  • More complete documentation available before surgeons meet with patients
  • Improved surgery start times
  • Better informed decisions
  • Accelerated ED discharges
  • Reduction in ED-to-inpatient admissions
  • Allergy reaction prevention
  • Reduced phone calls
  • Eliminating hand-written correspondence

The progress has accelerated since then. Health information exchange, especially across organizations using different market suppliers’ software, has rapidly expanded since passage of the 21st Century Cures Act in 2016, moving from how to exchange data to expanding what data is being exchanged. With the support of EHR developers, millions of clinical documents containing discrete data are exchanged every day using the Consolidated Clinical Document Architecture (C-CDA) standard – across state lines, and across organizations using different EHRs. Initiatives now in progress go beyond document exchange and will enable scaling of HL7® FHIR®-based API access to national network levels.

National private sector exchange collaboratives such as Carequality, the CommonWell Health Alliance, the eHealth Exchange, DirectTrust and SHIEC have been instrumental in the expansion of data exchange. They offer brokered and federated approaches, with record location services built in or available through other parties. Increased collaboration, common agreements, shared technical standards, and synchronized governance has led to substantial uptake in national, cross-state, and local exchange of patient data. 

Health information exchange, especially across organizations using different market suppliers’ software, has rapidly expanded since passage of the 21st Century Cures Act in 2016, moving from how to exchange data to expanding what data is being exchanged.

Notably, these initiatives are networks of networks, building on the success that health information organizations and other incumbents have already realized. These collaboratives focus on connecting existing networks to each other through common legal and technical standards, enabling distinct health information exchanges to connect without special effort and expand the number of organizations with which their participants can exchange health data. 

For example, state health information exchanges such as CRISP (Maryland), KHIN (Kansas) and MiHIN (Michigan) have already connected to each other using the Carequality framework. MiHIN is additionally connected through CommonWell. Single and multi-vendor networks have been able to connect within this network of networks. And because the eHealth Exchange is now also a Carequality implementer, its members, such as WISHIN (Wisconsin) and NMHIC (New Mexico), will be able to connect and exchange data with any other participant of any other Carequality implementer.

Alongside these initiatives, ONC is moving forward to implement a trusted exchange framework under the 21st Century Cures Act. While the Cures Act allows for development or support of a national framework for trusted exchange, EHRA has urged ONC to follow Congress’ intent and build on the momentum that’s been established. By supporting existing trusted exchange frameworks through TEFCA and the RCE rather than developing essentially a duplicate framework, ONC has the opportunity to bolster and further accelerate health data exchange efforts.

EHR developers share the healthcare industry’s vision for promoting greater use of interoperability tools and the numerous improvements to healthcare increased health information exchange can bring. We look forward to the discussions at this week’s Interoperability Forum


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