THE GOAL OF THIS PROGRAM is to provide an overview of interoperability in the context of health information technology (HIT), with a focus on how interoperability affects healthcare delivery. After studying the information presented here, you will be able to:


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3 Define “interoperability”


Identify three ways that nurses can influence the devel- opment of an interoperable health information exchange (HIE) system


Discuss two major challenges related to developing a fully interoperable HIE


By Meaghan O’Keeffe, BSN, RN, and Sarah R. Tupper, MS, RN-BC, LHIT, CPHIMS


You head to the nearest airport ATM, insert your debit card and within seconds, access your bank account to withdrawthe needed funds. You’ve just experienced interoperability. Interoperability is a fairly simple concept, but in healthcare, interoperability is deceivingly complex to achieve.


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What does it mean? As patients move through the healthcare system, relevant health information needs to be shared fromprovider to provider. Often this transfer of information occurs through paper copy, mail and fax and upon request.This fragmented information sharing results inmissing, redundant or erroneous data. This fragmentation may result in the delay of appropriate or timely care, unnecessary duplicate testing, increased readmissions and increased risk for medication errors.1 Interoperability describes the extent towhich systems and devices


can exchange data and interpret that shared data. For two systems to be interoperable, theymust be able to exchange data and subse- quently present that data such that it can be understood by a user.2 If health information remains chained within individual healthcare facilities and institutions, the electronic health record (EHR) will not differ much in utility fromthe antiquated paper medical chart. With electronic health information exchange (HIE), all the


players in healthcare delivery, fromnurses to physicians to phar- macists to community or public health providers, and even the patient, should be able to appropriately and securely access a patient’s vital medical information electronically. This improves the speed, quality, safety and cost of patient care. Patients can easily move back and forth between clinicians, unnecessary pa- perwork is eliminated, and there is a reduction inmedical errors and duplicate testing. Information exchange also supports larger public health goals, including public health reporting andmoni- toring, bioterrorismsurveillance, quality monitoring and clinical health trials.3


Interoperability is also associated with a simpler admissions process and a reduction in 30-day readmission rates.4


Which comes first, interoperability or EHR? Healthcare providers agree that the use of EHRs and the ability to share that information meaningfully are necessary for a safer and more comprehensive healthcare delivery. But how to arrive there is fraught with debate, including the most fundamental question: ShouldEHRsoftware first be designed with interoperability in mind or will interoperability naturally follow as more providers adopt


ou travel by plane to a destination a thousand miles away from home. Upon landing, you realize you don’t have any cash to pay for your cab ride to the hotel. No problem.


EHR? Some argue that to realize interoperability, the infrastructure for securely networking health information must be designed into theEHRfirst.Without that infrastructure, adoption of stand-alone EHR might keep information in “proprietary silos,” much like the papermedical record. Others say that as adoption ofEHRbecomes widespread, the ease with which data is shared will naturally follow.


Recent history To understand interoperability in our evolving healthcare system, a brief look at our recent history can help shed some light. In 2009, the Health Information Technology for Economic and Clinical Health Act was passed as part of the American Recovery and Reinvestment Act. Two agencies, the Centers forMedicare& Medicaid and the Office of the National Coordinator for Health Information Technology were chargedwith creating “a nationwide, interoperable, private and secure electronic health information system.” They needed to focus not only on thewidespread adoption of EHR, but also on ensuring that the use of EHR to its fullest potential would lead to safer, more effective healthcare delivery.5 Later, in 2011, as mandated by the Patient Protection and


Affordable Care Act, the Agency for Healthcare Research and Quality set out to develop the National Strategy for Quality Improvement inHealthcare.With input from a diverse group of stakeholders, including the public, theNational Quality Strategy was created to shape the aims and priorities of healthcare deliv- ery across the country. Priorities include person- (and family-) centered engagement with clear information and support, quality improvement achieved by supporting innovation and evaluation of national efforts, and bridging the gap between primary care, behavioral health, specialty clinics and health systems.6 The goals of theOffice of theNational Coordinator forHealth


Information Technology and the CMSto develop an HIE system that improves safety, quality and delivery of healthcare are aligned with many of the National Quality Strategy priorities. The destination is the same. And interoperability is the road that will take us there.


Interoperability and meaningful use “Meaningful use” refers to the ultimate goal of interoperability: that the widespread use of healthcare information exchange meets five aims: • Improvement in the quality, safety and efficiency of care while reducing disparity


• Engagement of patients and their families in their care • Promotion of public health • Improvement in care coordination • Promotion of privacy and security of EHR7 On a more practical level, “meaningful use” also refers to the


CMS incentive program, which is designed to reward healthcare providers and hospitals to both adoptEHR and use it to its fullest functionality to achieve those aims listed above. The program has been designed to have three stages of implementation;8


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requirements of each stage build on one another. Eligible providers and eligible hospitals must meet numerous core objectives for quality measurement, a few of which include: • An up-to-date problem list • An active medication list maintenance


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