Interoperability allows Health Information Exchanges to Thrive

What will we gain from interoperability? How far are we on the interoperability journey? Newcomer or expert, we all need to join the conversation. Let’s start off with defining some areas so we can discuss the subject.

Health Information Exchange (HIE)

If you don’t come from a background within Healthcare IT, it is possible that you have never heard the term health information exchange. Health information exchange (HIE) by definition is the pure ability to move healthcare and/or clinical information electronically across and between healthcare information systems within a hospital, community, or region. An HIE’s goal is to enable safer, time efficient, effective, and equitable patient-centered care through information sharing. But the term HIE also refers to the health information organizations within the United States (HIO) that facilitate the exchange e.g., hospital, state entity, or non-profit organization. [Source]



According to The Healthcare Information and Management Systems Society (HIMSS) article Interoperability in Healthcare, interoperability can be defined as: “…the ability of different information systems, devices, and applications (systems) to access, exchange, integrate and cooperatively use data in a coordinated manner, within and across organizational, regional, and national boundaries, to provide timely and seamless portability of information and optimize the health of individuals and populations globally…”

There are four  levels to interoperability (HIMSS):

  • Level 1: is referred to as the foundation and creates the inter-connectivity needs for systems or applications to ensure secure data exchange.
  • Level 2: is the structural aspect e.g. The format, composition, and organization of data exchange. It also includes data field level for clarification.
  • Level 3: the semantic level refers to the data’s codifications, models, elements, value sets, coding vocabularies etc.
  • Level 4: is the organizational level and contains governance, policies, legal aspects, and organizational aspects to ensure secure, seamless and effective communication.



Health Information Exchange and Interoperability

Level one foundation was laid by healthcare organizations using various electronic data sources that need to be capable of communicating between one another. For level two of interoperability, the USA and other countries are looking to standards such as Fast Healthcare Interoperability Resources (FHIR) or Open EHR  as a structural format. Interoperability for HIE is facing huge changes due to recent regulations such as the 21st Century’s Cures Act as well as guidelines from The Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS). Together they are enforcing policies and improving regulations for the industry pushing towards an improved Interoperability with common standards such as FHIR. [Source] 


Level one (foundational need) and level two (structural format) have been clearly defined by the industry and governmental requirements. Moving onto the 3rd level of interoperability for HIEs (which is where my knowledge lies due to working with HealthTerm), Level 3 or semantic interoperability can seem more complex, convoluted, and less defined on how to achieve it. Semantics are an important part of interoperability because:

“Achieving interoperable data would be less effective if there is no semantics in the communication components which can only be achieved when the process is interoperable. Semantic data interoperability means understanding of the data communicated between sender and receiver in such a way that the receiver easily interprets the sender intention of sending the data and properly responds.”


Without the understanding of the data sent (semantics), the receiver cannot properly respond to the information received. But how to get there? Semantic interoperability for HIEs can be achieved through healthcare data management. There are tools, such as HealthTerm, that address the data codifications, models, elements, value sets, coding vocabularies etc. Tools like HealthTerm can standardize and normalize the data to allow for the sender and the receiver to understand and use the data being exchanged.


Value of Interoperability for HIEs

Achieving semantic interoperability is of great value to HIEs and healthcare organizations. The value of fully standardized electronic health care information exchange and interoperability could yield a net value of $77.8 billion per year once fully implemented (achieving level 4). So not to say the least , semantic interoperability is a truly important area in the levels of interoperability that ensures efficiencies and cost savings.


According to Eric Pan in the article “The Value of Health Care Information Exchange and Interoperability” reaching Level 3, the semantic level of interoperability, could produce an annual nation benefit of approximately $44.1 billion. That value is comprised semantic interoperability cost savings in the following areas:

  • $18.8 Billion – hospital-based outpatient clinicians and external laboratories
  • $14.4 billion – imaging tests done at external radiology centers
  • $2.66 billion – outpatient providers and pharmacies
  • $8.11 billion – chart requests and referrals
  • $107 million – disease reporting

Achieving semantic interoperability in the above areas also means that patients will not have to repeat testing and be exposed to unnecessary x-ray, blood draws, and other tests. As well as reduce duplicate drug therapy or even avoid potentially harmful drug interactions. Chart requests and referrals can be done easily saving time and resources for both the patient and the healthcare organization. Also, disease reporting and vital statistics could provide earlier recognition of disease outbreak. The importance of which was proven during the COVID-19 outbreak. The value of semantic interoperability for HIEs and healthcare organizations has a dollar amount attached to it, but it can mean so much more for the patients and healthcare organizations by making healthcare more accessible and easier to navigate.



What makes semantic interoperability for HIEs truly important is the fact that it facilitates the breaking of silos by improving the data exchange within the healthcare system. If health information can easily be exchanged and understood between HIEs and within HIEs and participating organizations, it will benefit the clinician and the patient by enabling safer care, more informed and easier decisions, better care coordination, less fragmentation, and cost savings. Errors and duplications would be minimized in the health care experience or ecosystem. In conclusion, semantic interoperability is extremely important to HIEs and electronic medical records (EMRs) since it a huge factor in delivering enhanced societal, social (consumers’ welfare), and economical benefits.


For more information about the Cures Act:

For the interested reader more can be found here:

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