EHR interoperability:
benefits, barriers and best practices

EHR interoperability: benefits, barriers and best practices

March 3, 2023

EHR interoperability market statistics

projected value of the global healthcare interoperability solutions market in 2026

Research and Markets

out of 100 technology executives have hired data architects to define their interoperability strategies


The scope of EHR interoperability solutions

EHR interoperability principles suggest that all patient data – health and wellness – will be interconnected and available for action and research. According to Deloitte, health data streams will merge by 2040 and create a highly personalized and all-round view of every patient’s well-being.  EHR Interoperability includes:

Seamless integration of internal data, processes, and people to make the data actionable.
Timely external exchange to enable early disease detection and ensure cost transparency.
Streamlined and secured data access to improve service quality, patient outcomes, and consumer experience.
Insights from health data (clinical, claims, and device monitoring data) and social determinants of health (financial, housing, economic).

According to McKinsey, price transparency and data interoperability are emerging as big regulatory themes. Interoperable health information technology solutions should prevent data blocking and have standardized APIs.

Video title: Stephanie Carlton on price transparency
Data source: McKinsey & Company—The next frontier of care delivery in healthcare, 2022

Levels of EHR interoperability

The Healthcare Information and Management Systems Society (HIMSS) defines the four levels of health information technology interoperability:


Allows sending data between systems without its interpretation. For example, when a patient is discharged from the hospital, they receive a health summary in a PDF format.


Ensures the ability to send/receive information and interpret it at the level of data fields, which requires both sending and receiving systems to follow accepted data standards. E-prescription is a good example of structural level interoperability.


Allows digital health systems to exchange, structure, and interpret data correctly. Semantic interoperability enables providers to exchange patients’ health data with other providers who might employ different EHR systems.


Includes policy, governance, legal, social and organizational considerations to enable seamless, secure, and timely data communication, interpretation, and use within organizations and individuals. This level presupposes shared consent and integrated workflows and processes.

EHR interoperability benefits

Radically interoperable data, or just radical interoperability in healthcare, is a foundational capability required to enable the delivery of patient-facing programs and associated technologies.

Deloitte’s Future of Health 2040

Lower administrative costs

EHR systems interoperability enables healthcare organizations to reduce or redeploy full-time equivalent employees (FTEs) away from time-consuming manual processes, including quality reporting or obtaining authorizations, to tasks, which can directly contribute to reducing costs and improving patient care quality.

Regulatory compliance

Eliminating negative payment adjustments Avoiding penalties for noncompliance Reducing clinician burden

Data cleansing & aggregation

FTEs reduction and redeployment Acceleration of insight generation

Digital transaction management

Increasing throughput Reducing appointment cancellations and “no-shows” Eliminating treatment delays or prescription abandonment Increasing patient satisfaction

HIE integration

Streamlining care transitions Delivering continuous care Reducing errors and duplicate orders Increasing patient safety

Claim adjudication

Reducing penalties for missing or incorrect data Increasing accuracy and timeliness of payments

Higher efficiency of care delivery

Interoperability in the healthcare industry allows clinicians to access data in real-time, streamlining care delivery. On a larger scale, it helps to increase the number of patients receiving timely care and prevent adverse outcomes or misdiagnoses.

Intelligent appointment scheduling

Maximizing appointments Increasing health plan revenue Increasing use of in-network providers

Virtual care

Increasing market share Reducing the use of higher-cost care sites Increasing the number of managed patients

Alerts & notifications

Reducing emergency department (ED) visits Reducing manual handoffs and incomplete records Improving quality outcomes Reducing readmissions

Complete clinical record

Reducing time for chart prep Creating patient longitudinal record Expediting care transitions Facilitating authorizations

Lower total cost of care

Implementation of interoperable EHRs helps to reduce the total cost of care through efficient population health management techniques. A value-based care (VBC) reimbursement model, designed to replace the traditional fee-for-service model, rewards providers for the quality of rendered services. In a VBC world, interoperability helps to reduce hospital readmissions, improve patient engagement and lower costs.

Sites of care diversion

Reducing inpatient ED utilization Increasing the use of in-network vs. out-of-network providers increasing revenue while minimizing incremental costs

Price transparency

Cost-effective medication therapy Patient engagement in their care decisions Care team collaboration Avoiding regulatory penalties

Medication adherence tracking

Reducing prescription abandonment Intervening to improve patient outcomes Avoiding adverse events and their costs

Identification of candidates for care

Reducing gaps in care Increasing patient satisfaction

Higher revenue and growth

Interoperability can help healthcare facilities to increase revenue through streamlining communication and improving patient experience, achieving cost and quality performance targets and more effective patient steerage. Organizations prioritizing interoperability can acquire and retain patients more effectively, driving growth and revenue.

Patient steerage

Efficient patient transferring to other providers Increasing health system revenues

Patient analytics

Real-time quality monitoring Improving VBC contract performance

Care gap identification

Improving quality scores (such as MA Star ratings) Improving the ability to close care gaps

8 major EHR interoperability barriers

The COVID-19 pandemic put a severe stress test on EHR system readiness to manage the crisis. Moreover, the use of EHR increased the burden on healthcare providers (HCPs), according to a national randomized survey in Saudi Arabia. What are the core barriers to interoperable health records?

Homogeneity and consistency

Experts from Duke University evaluated EHR system readiness to manage the pandemic crisis and came to some disturbing conclusions. The lack of homogeneity in major EHR systems could complicate the work of clinicians.

Inconsistent data across the network is a significant challenge. Storing different pieces of information in numerous disparate places results in countless hours wasted searching for them. Adopting a single unified network and interface, automatically pulling out the necessary data from different silos, and creating a uniform dataset, can help.

[There is] The lack of a cohesive data model for patients in most electronic health records — an intuitively patient-centric construct that allows clinicians to start with a patient and trace back to their signs, symptoms, and diagnostic tests.

Erich Senin Huang

MD, Co-Director of Duke Forge and Assistant Dean for Biomedical Informatics, Duke University

Updates and scalability

Most EHRs are very complex, with many functions intertwined, which renders trouble-free updates and scaling virtually impossible. For providers, this is indeed a long and costly process. Duke University researchers revealed that modern EHR systems were unable to serve as population health management software amidst the crisis:

Tracking dozens of patients in an electronic health record system is feasible in many health care systems, but current capabilities are unlikely to scale to hundreds or thousands.

Eric D. Perakslis

PhD, Rubenstein fellow, Duke University

Unified patient identification

This issue concerns the lack of a patient identification standard accepted nationwide (NPID) that would assist with patient matching, lowering the rate of repeated tests and delayed care instances. Moreover, a unified patient number (UPI) could assist healthcare organizations with combating important EHR issues – overlays and duplicate entries, common culprits of patient misidentification.

In turn, patient misidentification may have graver consequences, such as erroneous prescriptions, repeated procedures and tests, and extra costs. Hence, ensuring correct patient identification remains the responsibility of providers.

Data sharing among payers

Insurance companies store loads of diverse patient data, and yet they are reluctant to share it with healthcare providers. With value-based care in place, providers and payers need to share data for efficient operation and have the same goal – reducing the cost of care with no harm to patients. 

Thus, payers need access to clinical information or the meaningful insights that data provides. At the same time, providers need details about patients’ demographics and social determinants that insurance agencies store. A clear view of the common goal can facilitate the mindset shift and help payers and healthcare facilities embrace mutual data sharing.

Cross-EHR communication

The Fast Healthcare Interoperability Resources (FHIR) standard has promptly become a protocol for connecting different healthcare-related systems to ensure cross-EHR communication. It is a “data transport layer” which actually enables interoperability. While most providers observe FHIR, the lack of rigid guidelines hinders seamless data sharing. 

The problem is that FHIR defines over 150 resources – the smallest possible units of meaningful data – but healthcare organizations typically choose to follow only some of them. This limited selection can undermine interoperability because the main FHIR concepts are interconnected. To establish interoperability with FHIR, providers need to make a set of components and resources required.

Integration costs

To ensure quality care, providers employ a range of health information technology systems – from EHR to hospital inventory management solutions and healthcare analytics tools – and should achieve seamless integration of these disparate systems.

However, many providers erroneously believe a health IT system integration is a costly investment that only large healthcare networks can afford. At the same time, most healthcare systems are typically integrated into the hospital’s IT environment upon implementation by IT vendors.

Patient data security

Patient data security can pose a serious challenge for EHRs. To enable seamless and safe data transmission, providers should put safeguards under the HIPAA Security Rule and other applicable standards. 

Technical safeguards are applied to the technological systems that access ePHI – electronic protected health information. Healthcare organizations should implement a mechanism to encrypt and decrypt electronic protected health information. They should also ensure transmission security measures to prevent unauthorized access to ePHI during its transfer.  

Resistance to data sharing

Certain healthcare providers may still resist sharing data with peers. For example, hospitals may compete for patients with urgent care clinics and have low motivation to share patient data if the request comes from emergency rooms.

However, health data should be accessible and available across organizational boundaries. The ONC’s Cures Act Final Rule calls on healthcare industry actors to adopt standardized APIs, which will enable individuals and healthcare providers to securely access structured electronic health information from mobile applications. If the data is not available, the provider could be fined and reported as a data blocker.

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How to improve EHR interoperability

A few technologies promise interoperability improvements, from cloud-based to blockchain EHRs. We’ll consider how they can assist with enabling full-scale interoperability and overcoming system communication barriers.

Moving to the cloud


EHR migration to the cloud is in high demand today. Cloud EHR implementation helps reduce overbearing costs healthcare providers have to endure by offering a pay-as-you-go model. 

Moreover, the cloud environment allows healthcare providers to take the security burden off their shoulders, at least partially. Most cloud EHR vendors offer round-the-clock support and expert cybersecurity services to keep PHI protected.


However, these advantages apply only to public and hybrid clouds. If providers decide to design EHR in a private cloud, they will bear hefty costs and need to have a professional in-house IT team.

Unfortunately, cloud environments are not free from interoperability issues either. The lack of standards hampers data sharing and impedes “communication” between different cloud tools.

Right now, interoperability is being done on an ad-hoc basis. What we need are some government regulations around cloud. The technology is there for interoperability, we just need to decide on some standards.

Zeus Kerravala

Founder and Principal Analyst, ZK Research

Adopting a blockchain EHR


The decentralized ledger technology may help provide enhanced EHR security and accessibility to medical professionals and patients.

Blockchain can also make a positive impact on semantic interoperability. With blockchain, there’s no need to implement costly integrations across different EHR systems. The only thing required to access patient records is a private key. This may enable access to health records for any medical professional and from any location, providing they have valid credentials.


With a blockchain EHR, patients become full-scale masters of their data, which may foster patient engagement. They grant access to their health information to providers, not vice versa. In this context, consumers are left to fight off cybercriminals and malicious actors on their own. 

As a result, they may fall victim to advanced fraud schemes like social engineering. Meanwhile, healthcare providers will have to learn new skills, from blockchain operation to marketing and advertising, to persuade consumers to become their clients.


A patient presents to hospital and is assessed by the provider


A test is completed and represented digitally as a block


The block is broadcast to the network for verification and approval


Approved blocks are added to the existing blockchain of patient health data


The patient and their providers can then access this test result using their private key from any location

Scheme title: How does blockchain work? How patients, providers, and healthcare systems could interact with a blockchain-based EHR system.
Data source: — Future of blockchain in healthcare: potential to improve the accessibility, security and interoperability of electronic health records

How to measure EHR interoperability

Measuring interoperability is a complex effort that may require extra time and effort from providers. The HIMSS Interoperability & HIE Committee has worked out eight measuring factors. Having examined how the following factors fit their healthcare system, providers may rate their interoperability scope and efficiency and identify the gaps.

Basic transactions

The ability of two systems to exchange data and the ability of the receiver to use the information. This metric measures a transaction type and volume.

Partners and stakeholders

Data exchange is considered at individual and population levels (provider to provider vs. provider to registries).

Standards applied

This factor includes message types and standards that enable the receiver to recognize and process data.

Profile-defined transactions

Transactions defined by profiles such as IHE, test venues and implementation guides. Data gathered during testing events and connectathons allows for measuring the standards’ adoption.

User specifics

The size, location, or specialty of healthcare organizations help to understand the settings that host interoperable transactions.

Transaction time

This factor measures whether the data is sent in real-time, delayed, or will be sent as one batch later.

Transaction volume

Significant increases or decreases in the volume of transactions and reported data can help to make plans for scaling up transactions.

Future plans

At this point, providers may develop strategies for bridging the gaps and advancing towards semantic interoperability with more healthcare systems if needed.

EHR interoperability standards and frameworks

There are several major standards, designed to boost EHR solutions interoperability.

The Trusted Exchange Framework and Common Agreement (TEFCA) is aimed to establish a universal floor for interoperability across the health IT ecosystem. It defines the infrastructure model and the approach for secure health data sharing among the network participants.

CMS Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule (CMS-0057-P). The rule highlights the need to improve data exchange and facilitate access to complete health records for providers, patients, and payers.

The Fast Healthcare Interoperability Resources (FHIR) is a standard focused on API that enables quick and efficient electronic health information exchange, including administrative and clinical data. FHIR-enabled applications give patients secure access to their EHI anywhere they go.

The United States Core Data for Interoperability (USCDI) is a standardized set of health data classes and elements for interoperable EHI exchange. Compliance with the USCDI standard is required as part of a new API certification criterion.

EHR interoperability: what is next?

EHR interoperability: what is next?

Healthcare interoperability is a complex matter for the modern healthcare industry, intended to allow the seamless sharing of patient data and improve patient care coordination and clinical decision-making. While functional and structural interoperability is already there, semantic interoperability has yet to be achieved. At Itransition, we help you build, implement and customize EHR solutions according to the latest interoperability principles and frameworks.

The overall rate leaves much to be desired, but signs of progress are visible. Evidence of that progress includes improved data sharing with outside EHRs, a growing ability for ambulatory clinics and smaller hospitals to connect with larger organizations, and more widespread use of national networks to achieve information sharing.

Trends in EMR Interoperability white paper

by KLAS Research and CHIME

EHR interoperability: what is next?

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FAQ about EHR interoperability

What is an example of healthcare interoperability?

EHR interoperability ensures that more information can be shared and used promptly. For example, a patient’s most recent blood test data, received at his local clinic, is available during his visit to the emergency care department on the same day. This can save time and help doctors make data-driven treatment decisions.

What are the risks of poor EHR interoperability?

Lack of EHR interoperability can affect patient safety and prove to be costly for healthcare providers. It can result in an increased risk of medical errors, excessive testing, increased time for diagnostics, and additional healthcare expenses.

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