Surmounting Barriers to Healthcare Data and Information: Cases in Point, the U.S. Experience

Abstract

Objective: The authors review the progress in healthcare interoperability from 2010 to 2023 in the United States. Interoperability, in the context of this paper, 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). This is followed by recommendations for future work toward improving the standardization of heterogeneous data in the healthcare setting. Methodology: A literature review was conducted on established interoperability standards and systems in healthcare based on information obtained from journal publications, government, academy reports, published materials, as well as publicly available websites. 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: 1) inter-facility (macro-tier) interoperability, 2) intra-facility (meso-tier) interoperability, and 3) Point-of-Care (micro-tier) interoperability. An evaluation of four interoperability parameters: 1) device/equipment interoperability, 2) compatibility issues, 3) involved organizations, and 4) migration and conversion issues are presented. The evaluation assessed the adoption levels of each standard by looking at factors that support or limit its systemic adoption. Estimations on the number of users—medical professionals and patients—for each system were made in instances where verifiable data were available. Results: This review reveals that… Conclusions: Despite many parallel ongoing efforts to improve the standardization of healthcare information, in the mobile devices, Internet of Things (IoT), and electronic health record (HER) sectors, there remains space for improvement. The recent development of the Trusted Exchange Framework and Common Agreement (TEFCA) greatly reduces the friction of data exchange in many healthcare contexts. In addition, funding architectures for mediating data between separate healthcare organizations, or middleware architectures, might also be an effective strategy for consolidating healthcare data and improving information exchange.