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EHR interoperability:
an end-to-end guide & best practices
April 17, 2025
EHR interoperability is the ability of EHRs to exchange data with various information systems, applications, and devices inside and outside the healthcare organization, enabling seamless and timely data access and usage by stakeholders for improved care coordination and patient outcomes.
Providing healthcare IT solutions for over 25 years, Itransition has rich experience in EHR development and integration with the healthcare IT ecosystem, ensuring uninterrupted data exchange within medical institutions and across multiple care facilities.
EHR interoperability market statistics
44%
of care providers agree that their EHR integrates with external systems as intended.
84%
of hospitals often send healthcare data to external providers.
Office of the National Coordinator for Health Information Technology
14.15%
the CAGR of the global healthcare interoperability solutions market from 2024–2030.
Levels of EHR interoperability
The Healthcare Information and Management Systems Society (HIMSS) defines the four levels of health information technology interoperability:
Foundational
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.
Structural
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.
Semantic
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.
Organizational
Includes policy, governance, legal, social, and organizational considerations to enable seamless, secure, and timely data communication, interpretation, and use by organizations and individuals. This level presupposes shared consent and integrated workflows and processes.
Ensure compliance of your EHR with leading interoperability standards
EHR interoperability standards & frameworks
There are several fundamental standards or frameworks for organizing data exchange in a way that ensures EHR interoperability.
The HL7 Standard contains three versions that cater to different needs. Depending on the government requirements or the standard used by other systems inside or outside the organization, healthcare providers can choose between V2, a legacy messaging standard, V3, which is a more robust and context-rich standard designed to fill in the V2 data sharing gaps, and FHIR (Fast Healthcare Interoperability Resources), a more secure, easier-to-implement, and flexible standards framework for exchanging lab results, clinical letters, scans, and other documents.
Digital imaging and communications in medicine (DICOM) standard provides rules for transmitting, storing, retrieving, printing, processing, and displaying medical imaging information. It comprises a network communication protocol that uses TCP/IP for system-to-system communication as well as a file format definition that details the structure of a DICOM file. DICOM aims to ensure the interoperability of hardware and software components used in medical imaging across diverse domains, including radiology, cardiology imaging, radiotherapy, ophthalmology, and dentistry.
The ICD-11 represents the eleventh revision of the WHO’s International Classification of Diseases, providing a universal language (code set and rules) for recording health information and causes of death. ICD-11 helps translate diagnoses into alphanumeric codes, allowing health professionals around the world to record, share, and analyze information. As a result, regardless of the clinician’s location and language spoken, healthcare specialists around the globe can exchange information about different health conditions with each other.
Systematized Nomenclature of Medicine – Clinical Terms (SNOMED CT) provides a general clinical reference terminology, giving IT systems a single shared language for easier, safer, and more accurate information exchange. It’s the world’s most complete and accurate collection of medical terms for use in electronic health records. SNOMED CT supports Meaningful Use, being one of the key terminologies adopted by The Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS).
The Trusted Exchange Framework and Common Agreement (TEFCA) aims to establish a universal framework for health information exchange (HIE) across the health IT ecosystem. It defines the infrastructure model and the approach for secure health data sharing among public health departments, healthcare organizations, and individuals.
CMS Interoperability and Prior Authorization Final Rule highlights CMS’s ongoing commitment to increasing interoperability and streamlining prior authorization processes. According to this rule, impacted payers operating in the healthcare industry are required to implement and maintain certain HL7 FHIR APIs to facilitate patient, provider, and pay-to-payer access and prior authorization tracking.
The United States Core Data for Interoperability (USCDI) is a standard providing health data classes (categories) and constituent data elements that healthcare organizations use to ensure consistent and accurate exchange of health information across systems and medical care settings. According to the new API certification criterion established by ONC, health IT developers must employ the USCDI standard when exchanging electronic health information.
A HIPAA-compliant EHR
with robust integration capabilities
Telemedicine-ready EHR
Itransition delivered an EHR solution and integrated it with a speech recognition software solution, an Automated System of handwriting recognition, and a secure portal for televisits to ensure the solution’s interoperability. Our team also equipped it with clinical text analysis capability that supports medical term recognition and matching it with SNOMED CT terminology. Furthermore, we made sure the developed EHR is compatible with systems of medical services providers, such as pharmacies, labs, etc., and complies with medical standards and regulations, like HIPAA, ONC, CEHRT, Section 508, and others.
700+
users across 30+ US medical institutions
Oncology treatment platform
Itransition’s team developed a HIPAA-compliant medical platform consisting of three interconnected modules—a knowledge base, a reporting module, and a precision medicine portal—to help practicing oncologists collect oncology treatment information from medical research, create treatment orders, and generate reports for recommended therapies. The solution integrates with the EHR system of the customer’s partner via API, which, in turn, connects to the several supported EMR systems and can be linked to data analytics platforms, insurance companies, labs, and other systems, improving data access and coordination of care.
A multi-tenant unified solution
compliant with HIPAA and FDA
Medical IoT solution for emergency care
Itransition delivered a unified solution for emergency care carts, improving care delivery quality and facilitating inventory management in resuscitation carts. The system is interoperable with healthcare facilities’ internal EHR systems, allowing for the smooth exchange of Code Blue-related patient records, billing requirements, and general patient health data. Communication between the EHR systems and the solution’s Central System is facilitated by a third-party interface engine utilizing the HL7 protocol, a widely recognized standard for exchanging electronic health records.
Enhance your healthcare practice with a fully interoperable EHR solution
How to ensure EHR interoperability
Following these key EHR interoperability best practices, healthcare organizations can achieve complete interoperability and overcome system communication barriers.
Adopt universal standards
Adhere to commonly used standards like FHIR and HL7 when developing integrations between healthcare systems to avoid incompatibility issues arising due to systems following different frameworks. Moreover, leverage a standard terminology and coding system (e.g., SNOMED CT, LOINC, ICD-10) recognized by all stakeholders to ensure data consistency across systems and its meaningful use for patient care.
Take advantage of the cloud
If you’re looking to enable seamless sharing of clinical data with any department, organization, vendor, or partner, consider moving to the cloud. Cloud platforms also allow for an easy scaling of data volumes stored, facilitating frictionless data exchange under increasing workloads while allowing you to preserve robust performance, data availability, security, and uninterrupted data flow.
Use open APIs
Employ publicly available APIs that adhere to EHR interoperability standards and get more freedom to integrate your EHR with various applications. Unlike private APIs that are typically intended for internal use, open APIs are publicly available to a wide range of developers and can be used to facilitate interoperability between different organizations. However, pay attention to open API tradeoffs regarding their higher vulnerability to cyberattacks and complement their implementation with well-thought-out security measures.
Nurture a data-driven culture
Build a data-driven culture, ensuring that your team clearly understands the value of information sharing. Start by securing leadership buy-in of the EHR interoperability project and their commitment to empower others to exchange data with stakeholders. Conduct regular meetings with employees to discuss what they’ve achieved due to EHR interoperability, what challenges they’ve faced, what data is needed to improve decision-making, and how the company should measure the impact of EHR interoperability on business and patient outcomes. To ensure your organization continuously benefits from EHR interoperability, invest in ongoing user training and reward employees for exchanging data.
Employ blockchain technology
Implement blockchain EHR to decentralize data management, enhancing system resilience and providing more transparency into data activities. Blockchain represents a distributed ledger protocol, which disseminates data across the blockchain network rather than keeping it in a central storage location. Patients become full-scale masters of their data, giving medical professionals access to healthcare data through a private key.
At the same time, blockchain prevents data tampering, loss, and unauthorized modifications, reflecting changes to data to all parties involved. This provides greater transparency toward data usage and can potentially enhance EHR interoperability. Some blockchain-based EHRs also come with solutions for simplifying data exchange, such as data pointers, which grant access to data stored across different medical jurisdictions.
Scheme title: Blockchain-based EHR framework
Data source: mdpi.com —
Blockchain-Based Healthcare Records Management Framework
EHR interoperability challenges & solutions
The complexity of ensuring seamless EHR interoperability is a major obstacle to its adoption among healthcare providers. Here are the main challenges of EHR interoperability enablement to be aware of, as well as solutions to minimize their negative impact.
Problem | Solution | |
|---|---|---|
Privacy & security concerns |
According to the HIPAA Journal, in 2024, more than 250 million individuals were affected by healthcare security breaches, compared to 50 million in 2022, which is a 400% increase.
EHR systems collect a lot of personally identifiable information about patients and employees, which makes
them a primary target for cybercriminals.
| To enable seamless and safe data transmission, implement a mechanism for encrypting electronic protected health information (ePHI) in transit, such as TLS protocols. Also, integrate strong user authentication methods, such as biometrics and multi-factor authentication, and VPNs to secure connections and prevent unauthorized access to medical records. |
High costs |
Ensuring the interoperability of EHR with diverse health information technology systems, from hospital
inventory management solutions to healthcare analytics tools, is a costly investment that smaller
healthcare facilities, physician practices, and rural hospitals can’t always afford.
| Implement EHR interoperability solutions step by step, investing in critical integrations first and then gradually adding more as you see the value of EHR interoperability. Besides, consider applying for grants, subsidies, and other incentives available in your country for a partial or full funding of your EHR integration project. |
Regulatory complexity |
Regulations like HIPAA can impose strict data compliance requirements, discouraging healthcare providers
from sharing patient records.
| Make sure your EHR interoperability solutions comply with industry-specific regulations by default and consider partnering with experienced tech service providers who are well-versed in healthcare regulations and can help you maintain compliance. |
Resistance to change |
The need to switch from familiar workflows to new data-sharing requirements makes healthcare professionals
reluctant to make extra effort to share data and resist the change.
| Involve several parties, including patients, clinicians, internal health IT specialists, EHR vendor representatives, and a third-party consulting firm, to work closely together to ensure the convenience of data exchange processes between your EHR and the rest of your IT ecosystem. Provide support to your employees when needed and show by example how EHR interoperability can improve the quality of care. |
Benefits of EHR interoperability
EHR interoperability promises numerous benefits for a wide range of stakeholders, from patients and healthcare providers to payers and researchers. It simplifies patient care transitions, reduces risks of medical errors, increases the chances of positive treatment outcomes, and lowers medical organizations’ costs.
Increased workflow efficiency
With EHR interoperability ensured, clinicians can automate manual data collection and eliminate redundant data entry and administrative tasks, which reduces physicians’ burden.
Enhanced care coordination
Thanks to EHR interoperability, communication between healthcare providers is simplified, which eliminates repeated tests, conflicting treatment recommendations, and any misunderstandings.
Improved patient care
With access to integrated medical data in EHR, care providers can make more informed decisions about the best course of treatment, create highly personalized treatment plans, and ensure care continuity, improving patient experience and satisfaction.
Reduced costs
With EHR systems interoperability achieved, healthcare organizations can avoid unnecessary or duplicative testing and imaging procedures, serve more patients by freeing up clinicians’ time, and reallocate full-time equivalent employees (FTEs) away from time-consuming manual processes to more value-adding ones.
Advanced research & public health initiatives
With interoperable EHR systems in place, research specialists can analyze data of patients worldwide, from their disease progression to health outcomes, facilitating medical research, new drug discovery, and clinical trials.
Diminished medical errors
By ensuring automated data entry and exchange, healthcare providers minimize the risks of mistakes caused by human negligence, preventing prescription errors and misdiagnoses.
Empowered patients
Thanks to easier access to complete health records and test results, patients can better understand their doctors’ medical decisions, be more engaged in their care, and track their health progress.
Healthcare scalability
By achieving EHR interoperability, healthcare providers can accelerate decision-making and care delivery and, potentially, examine more patients.
Ensure EHR interoperability for superior healthcare provision
EHR interoperability helps ensure seamless sharing of patient data and improve patient care coordination and clinical decision-making. While demanding and frequently requiring the collaboration of multiple stakeholders, this initiative is attainable through investing in robust and scalable integration solutions that facilitate cross-continuum patient information exchange.
At Itransition, we help you build, implement, and customize EHR solutions equipped with comprehensive functionality and robust security features. We also integrate EHRs with other software according to the required interoperability principles and frameworks to ensure clinician and patient access to health records, streamlined communication between stakeholders, and, ultimately, patient safety and better care.
Want to make your EHR solution interoperable?
FAQs
EHR interoperability principles suggest that all patient data, including basic information about treatment plans, prescriptions, lab test results, demographic information, and immunization records, should move effortlessly between systems and be available to healthcare organizations, caregivers, patients, and payers for various purposes.
EHR interoperability streamlines inter-organization communication and reduces duplicate laboratory and radiology testing, excessive interventions, emergency department costs, and hospital admissions.
To achieve EHR interoperability, it’s essential to use standardized data formats, comply with HIPAA, HITECH, and other regulations, collaborate with end users right from the start of the project, and train employees before and after implementing interoperable systems and reshaping care delivery workflows.
To evaluate the interoperability of the EHR system, providers should assess eight measuring factors devised by the HIMSS Interoperability & HIE Committee:
- Basic transaction type and volume
- Partners and stakeholders involved in health data exchange
- Standards applied
- Transactions defined by profiles such as IHE, test venues, and implementation guides
- User specifics (size, location, or specialty of healthcare organizations) to understand the context for EHR interoperability
- Transaction timing (real-time, delayed, batch)
- Transaction volume fluctuations
- Future plans of the healthcare organization, such as achieving semantic interoperability or expanding on types of transactions, to determine the EHR capacity to support these
Integration of AI and machine learning into healthcare IT ecosystems and expanding adoption of IoT devices and patient engagement tools increase the demand for EHR interoperability as they entail real-time collection and analysis of vast amounts of data and require access to large volumes of patient data.
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