Interoperability
Healthcare interoperability is the ability of different health information systems and software to exchange, interpret, and use shared data — mandated by the 21st Century Cures Act and operationalised through ONC's information blocking rule and FHIR-based API requirements.
What is Interoperability?
Interoperability in healthcare refers to the capacity of health information technology systems to exchange and use clinical and administrative data seamlessly, without special effort from the user. The HIMSS defines four levels: Foundational (basic data exchange), Structural (format and syntax), Semantic (shared meaning and terminology), and Organisational (policy, governance, social factors). True semantic interoperability — where the receiving system can interpret and act on data from a sending system — remains aspirational for most US health systems.
21st Century Cures Act and Information Blocking
The 21st Century Cures Act (2016) and implementing rules by ONC make it illegal for health IT developers, health information networks, and healthcare providers to engage in "information blocking" — practices that are likely to interfere with the access, exchange, or use of electronic health information (EHI). Eight exceptions are defined (Privacy, Security, Preventing Harm, Licensing, Costs, Infeasibility, Health IT Performance, and Content and Manner). Violations can result in civil monetary penalties of up to $1 million per violation for health IT developers and $100,000 per violation for providers and health networks.
TEFCA: Trusted Exchange Framework
The Trusted Exchange Framework and Common Agreement (TEFCA) provides a universal floor of interoperability across the US healthcare system. Participating Qualified Health Information Networks (QHINs) — including eHealth Exchange, CommonWell, Carequality, and others — enable nationwide data sharing for treatment, payment, operations, public health, individual access, and healthcare oversight use cases. TEFCA went live in 2023 with initial QHINs and is expanding.
Data Exchange vs Data Portability
An important practical distinction: Data exchange refers to real-time, application-to-application data sharing (FHIR APIs, HL7 V2 feeds). Data portability refers to the ability to extract and transfer data in a usable format (CSV exports, CDA documents). For many analytics use cases — population health, quality reporting, revenue cycle analysis — structured CSV exports from EHRs are fully functional and often more reliable than FHIR API implementations. The focus should be on data completeness and quality, not the transfer mechanism.