DISCUSSION 1 According to HIMSS, interoperability “describes the extent to

                                                                            DISCUSSION 1

According to HIMSS, interoperability “describes the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.” There are four levels of interoperability:

  1. foundational
  2. structural
  3. semantic
  4. organizational

Foundational interoperability: the ability of one I.T. system to send data to another I.T. system. The receiving I.T. system does not necessarily need to be able to interpret the exchanged data — it must simply be able to acknowledge receipt of the data payload. This is the most basic tier of interoperability.


Structural interoperability: “the uniform movement of healthcare data from one system to another such that the clinical or operational purpose and meaning of the data are preserved and unaltered,” HIMSS states.
In order to achieve structural interoperability, the recipient system should be able to interpret information at the data field level. This is the intermediate level of interoperability.


Semantic Interoperability: the ability of health I.T. systems to exchange and interpret information — then actively use the information that has been exchanged. Semantic interoperability is the highest level of interoperability.“Semantic interoperability takes advantage of both the structuring of the data exchange and the codification of the data, including vocabulary so that the receiving information technology systems can interpret the data,” stated HIMSS.

Achieving semantic interoperability allows providers to exchange patient summary information with other caregivers and authorized parties using different EHR systems to improve care quality, safety, and efficiency.
This level of interoperability allows healthcare organizations to seamlessly share patient information to reduce duplicative testing, enable better-informed clinical decision-making, and avoid adverse health events.
Effective health data exchange can also help to improve care coordination, reduce hospital readmissions, and ultimately save hospitals money.  

“New” Organizational (Level 4) – includes governance, policy, and social. While semantic interoperability is the goal, most healthcare organizations are still working to establish foundational and structural interoperability.
Hospitals and health systems can utilize existing health data standards to achieve lower levels of interoperability and set a solid foundation for future improvements in health data exchange.

Evaluate one of the Interoperability levels listed above.

Include the following aspects in the discussion:

  • Using your text and other      course resources, assess one of the following levels listed above and its      importance in achieving full interoperability.
  • Discuss technical and      economic barriers hospitals face in achieving your chosen level of      interoperability.
  • Explore the role the      government plays in your chosen level.
  • Share suggestions as a      health care leader to support the development of your chosen level.


Classmate’s Discussion 1

Foundational interoperability involves the close organization and teamwork of diverse investors, including patients, providers, and health information technology (I.T.) professionals. Yet, the U.S. healthcare delivery system remains to have a culture defined by owners, where data have become more of a product and inexpensive profits than a basis for organized care. According to (Interoperability and the Connected Health Care System | CMS, n.d.) There have been many accusations over foundational interoperability issues with I.T. systems accused of “information blocking” or purposely tampering with the flow of information between different I.T. systems. Foundational interoperability often intimidates vendors into accepting and using certain HIMSS, rather than enabling collaboration across these technologies (Healthcare Interoperability: 3 Top Barriers| Kanda Software, n.d.).

Healthy foundational interoperability can enable organizations to gain abilities by collaborating with government enterprises to promote efficient patient services (Interoperability and the Connected Health Care System | CMS, n.d.). As a result, the government plays a role in better healthcare opportunities and economic development opportunities. In addition, foundational interoperability that involves the government is essential for companies that work together and exchange intellectual business relationships. The government, therefore, establishes vigorous foundational interoperability that can directly benefit the economy to enable better-informed clinical decision-making and safer healthcare practices.

All healthcare facilities must accept foundational interoperability because that’s the only way in which they can achieve their goal of sending data to another I.T. system. Developing patient data will enable me to provide healthcare without delays as a healthcare leader. Although the data comes in different levels, I can also support the development of foundational interoperability by using the proper clinical decisions. As a healthcare leader, I must consider the patient’s medical records as not their possession but that of the patients.

Healthcare interoperability: 3 top barriers and how to overcome them. Kanda Software. (n.d.). Retrieved October 23, 2022, from https://www.kandasoft.com/healthcare-interoperability-3-top-barriers-and-how-to-overcome-them/

Interoperability and the Connected Health Care System. CMS. (n.d.). Retrieved October 23, 2022, from https://www.cms.gov/blog/interoperability-and-connected-health-care-system

                                                                   DISCUSSION 2

Information blocking poses a threat to the benefits of EHRs and health I.T. The Office of the National Coordinator for Health Information Technology (ONC) describes information blocking as the intentional and unreasonable blocking of health information among health I.T. systems. This practice does not include the blocking of information for health data privacy reasons or because of reasonable barriers. Federal organizations, including The Centers for Medicare & Medicaid Services (CMS) and ONC, have increased pressure on providers and health I.T. companies still engaging in information blocking. In addition to federal policies, incentive programs also underscore the importance of putting an end to information blocking. As part of the Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program (QPP), providers must attest to the prevention of information blocking reporting requirements. There are several actions ONC and other federal agencies can take to address certain aspects of the information blocking problem.

These actions include:

  1. Proposing new      certification requirements that strengthen surveillance of certified      health I.T. capabilities “in the field.” 
  2. Proposing new transparency      obligations for certified health I.T. developers that require disclosure      of restrictions, limitations, and additional types of costs associated      with certified health I.T. capabilities.
  3. Specifying a nationwide      governance framework for health information exchange that establishes      clear principles about business, technical, and organizational practices      related to interoperability and information sharing.
  4. Working with the Centers      for Medicare & Medicaid Services to coordinate health care payment      incentives and leverage other market drivers to reward interoperability      and exchange and discourage information blocking.
  5. Helping federal and state      law enforcement agencies identify and effectively investigate information      blocking in cases where such conduct may violate existing federal or state      laws.
  6. Working in concert with      the HHS Office for Civil Rights to improve stakeholder understanding of      the HIPAA Privacy and Security standards related to information sharing.
Reflect on ways to prevent Information blocking.

Include the following aspects in the discussion:

  • Choose one of the actions      to address the information blocking problem
  • Choose an aspect not      already chosen by a peer
  • Find two scholarly recent      (less than three years) references about your chosen action
  • Summarize the action and      explain how it can help with solving the issue
  • Discuss the reasons      why providers and vendors are still engaging in information blocking and      the impact on patient outcomes


                                                     Classmate’s Discussion 2

2009 Health Information Technology for Economic and Clinical Health (HITECH) Act was passed by Congress. HITECH offered financial incentives providers and hospital systems to improve the interoperability of their systems. Essentially, HITECH gave money to providers, hospitals, and hospital systems if they made health information exchange easier (this excludes confidential information). This allows vendors, the creators of health information technology, to increase their revenue by charging higher process for more electronic health information (EHI) technology that meets the compliancy standard. In addition, vendors may also increase earnings by decreasing the interoperability so that they can charge higher prices for EHI systems. Research indicates that 50% of Electronic Health Record vendors actively participate in information blocking. While only, 25% of hospitals actively engage in information block and another 34% admit to blocking information occasionally (J. Alder-Milstein, 2017).

Interoperability impacts the safety of patients. Interoperability decreases lab and radiology tests, decreases duplicate procedures thus increasing patient safety and curbing the economic burden of health care (N. Menachemi, 2018).

Action and References

Pat research noted that 91% surveyed vendors, providers, hospitals, and hospital systems noted that clear national laws (nationwide governance framework) pertaining to interoperability and data sharing would be either very effective or moderately affective. According to my research, a multi-tier approach could be the gold standard in the future. In addition, mandatory comparing of vendor products, prohibiting the gag clause and encouraging the public to report when there are issues is estimated to be 93% effective. Lastly, legislation requiring vendors to demonstrate their products interoperability to potential IT clients is estimated to be 92% effective (J. Alder-Milstein, 2017). The current lack of inoperability has proven that anything less than a multi-tier approach will not be effective.

Summary and Explanation of Action

Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”) attempted to provide a legal framework for providers and hospitals that were reimbursed through the Medicare system (a subset of the population). On a larger scale, The Cares Act was passed by Congress which penalizing and prohibited information blocking. The Office of the National Coordinator for Health Information Technology (“ONC”) and the National Institute of Standards and Technology, stating that both public and private entities must work together to support a framework (C. Knooth, 2020). With the framework in place, the remaining steps of prohibiting the gag clause and encouraging the public to report issues are the remaining steps according to research (J. Alder-Milstein, 2017).


C. Knooth, G. S. (2020, May 27). Can Electronic Health Records Be Saved? American Journal of Law and Medicine, 46(1). doi:https://doi.org/10.1177/0098858820919552

J. Alder-Milstein, E. P. (2017, March 7). Information Blocking: Is It Occurring and What Policy Strategies Can Address It? Milkbank Quarterly, 95(1), 135. doi:10.1111/1468-0009.12247

N. Menachemi, S. R. (2018, September). The benefits of health information exchange: an updated systematic review. Journal of the American Medical Informatics Association, 25(9), 1259-1265. doi:https://doi.org/10.1093/jamia/ocy035

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