Modern consumers have high expectations when it comes to accessing information, and many now expect to have quick and continuous access to records about their health and care. That’s why many healthcare organizations are building health information exchanges (HIE), which are specialized networks that rely on interoperable systems to share electronic health information seamlessly and securely.

Even though the adoption of EHRs was a good first step towards building HIEs, there are still many challenges that need to be overcome to achieve the level of interoperability needed to obtain the full benefits of HIEs. These challenges include:

Lack of standardization: Although standard record formats like FHIR and HL7 are becoming more common and new regulations are pushing EHR vendors to provide APIs that support interoperability, many providers and healthcare systems use customized EHR systems that can be hard to convert to a standard format and shared with others.

Security: Healthcare organizations can find it hard to balance the need for health information to be accessible with the need to secure sensitive information and maintain patient privacy, especially with the increasing number of cybersecurity attacks on healthcare systems.

Consent: By building digital health systems in which health information flows freely from provider to provider, it’s not always clear when patient consent is needed and what level of consent is needed. Healthcare organizations are understandably cautious about this and tend to error on the side of not sharing information.

Professional burdens: When new tools for recordkeeping are introduced, people need to learn how to use them. Healthcare professionals are often wary about new systems since EHR systems often do a better job supporting administrative and billing workflows than clinicians' needs.

These challenges are not insurmountable. With advances in cloud computing, especially hybrid cloud, it’s become easier for organizations to move and secure data in a consistent way. Cloud environments provide opportunities for organizations to build data pipelines that standardize data to an industry-standard format like FHIR and provide secure access to people who need it – whether they’re payers, providers or patients themselves.

CMS efforts to promote interoperability

In 2016, President Obama took a major step to solve information blocking by signing the 21st Century Cures Act, which requires EHR systems to provide a patient-facing API to maintain their federal certification. In 2020, the Centers for Medicaid & Medicare Services (CMS) issued a rule requiring health plans and providers who receive federal funds from their programs must take steps to make health information easier to access.

Most of the policies focus on encouraging payers to implement application programming interfaces (APIs) and data exchanges that provide secure access to their provider directories, patient claims data and other resources that would make it easier for data to be accessed in a timely manner. This access would give patients, as well as providers and payers, a more holistic view of the care people receive and support broader public health efforts.