Pragmatic Approaches to Interoperability in the U.S.: Surmounting Barriers to Healthcare Data and Information Across Organizations

Abstract

Objective: This article reviews the landscape of interoperability efforts in healthcare from 2010 to 2023 in the U.S. and abroad. Interoperability, in the context of this article, is “the ability to share information across time and space from multiple devices, sources, and organizations,” as defined by the IEEE (Institute of Electrical and Electronic Engineers). The review is followed by recommendations for future work toward improving the standardization of heterogeneous data in the healthcare setting. Methods: A literature review was conducted on established interoperability standards and systems in healthcare based on information obtained from journal publications, government and academy reports, published materials, and publicly available websites. Emphasis is placed on four interoperability parameters: device/equipment interoperability, compatibility issues, involved organizations, and migration and conversion issues. It evaluates adoption levels for each standard, as well as factors supporting and/or limiting systemic adoption. Estimations on the number of users—medical professionals and patients—for each system were made when verifiable data were available. Examples of specific interoperability efforts and an evaluation of their feasibility were conducted at three levels of healthcare interoperability, as defined by the National Academy of Medicine: Inter-facility interoperability, Intra-facility interoperability, and Point-of-care interoperability. Results: After reviewing the following interoperability initiatives: Health Level 7 (HL7), Consolidated-Clinical Document Architecture (C-CDA), Digital Imaging and Communications in Medicine (DICOM), Integrating the Healthcare Enterprise International (IHE), Fast Healthcare Interoperability Resources (FHIR), Argonaut, Direct Standard, Validated Healthcare Directory (VHDir), Health Quality Measures Format (HQMF), Health Relationship Trust (HEART), and Prescription Drug Monitoring Program (PDMP) which operate in various clinical domains, it is clear that while progress has been achieved locally, greater semantic understandability during information exchange is necessary. Greater detail is presented in each section. Conclusions: Despite many parallel ongoing efforts to improve the standardization of healthcare information in the mobile devices, IoT (Internet of Things), and EHR (electronic health records) sectors, there is still space for improvement. The U.S. must develop and implement effective mechanisms to surmount boundaries blocking the transfer of diverse types of healthcare information.