A complex health care system requires diverse electronic health record (EHR) products. One size does not fit all. To realize their full potential, EHR products must be able to share information seamlessly. An interoperable health IT environment makes this possible.

EHR Interoperability enables better workflows and reduced ambiguity, and allows data transfer among EHR systems and health care stakeholders. Ultimately, an interoperable environment improves the delivery of health care by making the right data available at the right time to the right people.

The Office of Standards & Interoperability

To help build nationwide EHR interoperability, the Office of Standards & Interoperability (OSI) at the U.S. Department of Health and Human Services works to:

• Encourage development of health IT standards
• Move toward the seamless exchange of health data across all stakeholders: Federal agencies; State, local, and tribal governments; and the private sector

To achieve these goals, OSI's roles include:

• Enabling stakeholders to come up with simple, shared solutions to common information exchange challenges
• Curating (overseeing) a portfolio of standards, services, and policies that accelerate information exchange
• Enforcing compliance with validated information exchange standards, services, and policies — to assure interoperability among validated systems

Where Standards Matter Most

In creating an interoperable health IT environment, standards are particularly critical in four areas of EHR technology:

• How applications interact with users (such as e-prescribing)
• How systems communicate with each other (such as messaging standards)
• How information is processed and managed (such as health information exchange)
• How consumer devices integrate with other systems and applications (such as tablet PCs)

A First Step Toward Interoperability: The Direct Project

The Direct Project is creating a low-cost, practical mechanism for exchanging health information over the Internet. Direct makes it possible for providers to securely email information via their EHR to other trusted providers, such as specialists, pharmacies, and laboratories. The mechanism is:

• Simple. Connects participants by allowing them to securely transmit messages in an encrypted manner.
• Secure. Makes it easy for participants to verify that messages are complete and not tampered with en route.
• Scalable. Achieves Internet scale without the need for a central network authority to provide sophisticated services.
• Standards-based. Built on well-established Internet standards, commonly used for secure email communication.

The Direct Project doesn't replace other ways of exchanging information electronically. It augments them. It does replace slow, inconvenient, expensive methods of exchange (such as paper and faxes), providing a path to more advanced interoperability.

Direct Project standards and specifications are the result of an open, collaborative process involving public and private stakeholders. Pilots are underway in 2011, with completion slated for 2012.

Learn more about the Direct Project

A Work in Progress

The Nation's move toward a fully interoperable health IT environment is a work in progress, with new developments every day. It's important to keep in mind that older EHR systems may not be fully compatible with newer products. Systems that predate current standards may require installation of applications that function as translators.