Interoperability in healthcare means different computer systems and software can work together. They share and use data in a way that helps doctors and nurses. For medical offices, interoperability lets patient information be shared quickly across many platforms. This helps with better care, less repeated testing, and good decisions by healthcare workers.
The United States has made progress with electronic health records (EHRs). This is partly because of laws like the Health Information Technology for Economic and Clinical Health (HITECH) Act and the 21st Century Cures Act. These laws encourage doctors to use digital records and make good use of patient data. Even so, sharing data between different systems is still hard. Different systems use different formats and rules, which makes data exchange tricky.
Two standards help improve data sharing in healthcare: SMART and FHIR.
SMART and FHIR together provide a common way to share and use health data across EHRs, mobile apps, and other health tools.
In the U.S., SMART on FHIR is used in major EHR platforms found in hospitals and clinics. For example, Apple’s Health app uses SMART on FHIR. It lets people link health data from devices like fitness trackers to their EHRs. This helps patients have more access and control over their health information.
Healthcare groups are using SMART and FHIR more to follow federal rules about data sharing. The 21st Century Cures Act requires the use of FHIR-based APIs. These APIs allow real-time access to health data and stop information blocking. These laws push health systems to provide digital services that reach beyond hospitals.
Patient involvement with EHR systems can lead to better health. SMART on FHIR supports this by letting patients use portals and apps to see and use their data. Studies showed that nearly 60% of patients in 2020 could access their EHR portals, which is more than before. The number of people downloading their EHR information doubled from 2017 to 2020. Around 20% connected their health data to other caregivers or apps.
There are still problems, though. Some people in rural areas have poor internet access. Older adults may not know how to use smartphones. There are differences in portal use based on race and education. These issues show that access to digital health tools is not equal for everyone.
Patients who share their EHR data help make clinical research more diverse. For example, the DETECT study by Scripps Digital Trials Center had over 40,000 participants. About 10% connected their EHRs remotely. This improved the quality and variety of data for COVID-19 research. Groups often underrepresented in studies made up 30.4% of participants in some parts, showing how interoperability can include more people and make research easier for them.
Interoperability is also important in laboratory information systems (LIS). These systems manage lab tests, results, and connect with EHRs. A review of 28 studies found that 22 succeeded in integrating LIS using standards like HL7 and FHIR.
These integrations help labs work faster and share data automatically with hospitals. Still, some problems remain. These include data mismatches, security worries, and the need to change systems when standards update.
Lab managers and medical practice leaders need to make sure LIS and EHRs work well together. This ensures test results are shared quickly and data stays accurate for good care decisions.
While this article talks about the U.S., it is useful to know the global work on health data sharing. The World Health Organization (WHO) works with HL7 International to promote open standards like SMART on FHIR around the world. Part of this effort is to support six main languages: English, Spanish, Chinese, Arabic, French, and Russian.
This helps remove language barriers that stop countries from sharing health information. For U.S. healthcare groups that serve many different people, global standards help ensure future health systems are inclusive and able to work together internationally.
Federal laws play a big part in speeding up interoperability. The HITECH Act helped spread EHR use in the U.S. by offering financial help. Later, the 21st Century Cures Act required EHRs to use FHIR APIs and prevent data blocking.
These rules make EHR companies build open systems. They give patients better access to their data. They also allow outside developers to make patient-focused apps using SMART on FHIR.
Healthcare groups that follow these rules can expect smoother workflows, better team care, and happier patients.
Artificial intelligence (AI) and workflow automation are now part of interoperability. They help healthcare work better and faster. For medical practices managing complex EHR data, AI tools offer many benefits.
AI can use data from FHIR APIs to study patient history, lab tests, and medications in real-time. It helps doctors make good choices. AI can spot disease signs early, suggest care plans, and reduce mistakes.
AI also helps with tasks like scheduling, billing, and talking to patients. For example, companies like Simbo AI use AI to answer phones and help with front-office work. These systems connect with EHRs to improve patient calls, reduce waiting, and make scheduling accurate. This frees staff to focus on other tasks.
The COVID-19 pandemic made telehealth and remote monitoring grow fast. They both depend on data sharing. AI looks at data from wearables connected by SMART on FHIR apps. It alerts doctors about patient health remotely and automates routine follow-ups.
AI systems can handle large amounts of data from many EHRs, labs, and devices. They clean and standardize data to keep it correct. Cloud storage lets data systems grow easily without healthcare needing special equipment.
With more data sharing, strong privacy and security are important. Especially with API data exchange and AI systems. Patient identity checks, secure data transfers, encryption, and audit logs help keep information safe.
HL7 FHIR includes security rules to lower risks of data breaches. Federal laws like HIPAA must be followed to keep patient trust while sharing data better.
Healthcare IT managers in the U.S. need to carefully choose tech vendors. They must keep watching systems to meet rules and prevent security problems.
SMART and FHIR are key standards that help different EHRs and health platforms work together in the United States. They support better patient involvement, improved clinical work, and bigger research chances. They also follow federal laws that improve health data access. When combined with AI and workflow automation, these standards give medical administrators, owners, and IT managers useful tools for today’s healthcare needs.
Advancements include patient-facing tools that allow patients to access, interact with, and share their EHR data using mobile and desktop devices. These tools also enable connection of external health data sources like wearable fitness trackers and genomics data, improving patient engagement and contributing to richer data for clinical care and research.
SMART (Substitutable Medical Apps and Reusable Technology) and FHIR (Fast Healthcare Interoperability Resources) establish technical standards that enable seamless exchange and access of EHR data across different systems. Their adoption allows integration of apps and tools with various EHR platforms, improving interoperability and facilitating the development of patient-centered digital health services.
The pandemic highlighted the need for remote patient monitoring and telehealth, driving rapid adoption of digital health technologies. EHR systems incorporated COVID-19-specific templates and predictive models and supported remote data capture, facilitating decentralized clinical trials and real-time research efforts leveraging EHR and wearable data.
It allows patients to directly share their comprehensive health data with researchers, enhancing data richness and enabling decentralized, siteless clinical trials. This approach helps reduce participant burden, promotes inclusivity, increases sample size, and improves representation of underrepresented groups in biomedical research.
Barriers include the digital divide—lack of broadband internet, especially in rural areas—and low smartphone ownership among older adults. Additionally, disparities by race, age, and education affect EHR use. Limited ability to edit personal health data and concerns about privacy and security further restrict patient engagement.
Policies like the HITECH Act incentivized widespread EHR adoption, while the 21st Century Cures Act mandates use of FHIR standards to promote meaningful patient use and data sharing. These laws accelerate interoperability, expand patient-facing digital services, and encourage patient-mediated data exchange with researchers.
Cloud-based clinical data warehousing, entity extraction, terminology standardization, and record linkage services are evolving to manage data aggregation from multiple sources, handle missing or discrepant data, and improve scalability of health IT applications without developing solutions from scratch for each use case.
Active patient engagement can transform the EHR from a static record to a dynamic tool providing risk assessments, personalized outcome predictions, and early disease detection by integrating diverse health data and enabling real-time feedback to patients and providers for proactive care.
Concerns include verifying user identity, securing data transfer, protecting against unauthorized access, maintaining confidentiality during data sharing, and improving deidentification techniques. Robust safeguards are essential to prevent medical errors and protect patient information from misuse or fraud.
AI agents can analyze integrated EHR and mobile health data to provide timely clinical decision support, personalized health insights, and facilitate remote monitoring. This integration enhances care coordination, streamlines workflows, supports decentralized trials, and accelerates research by leveraging comprehensive, real-time patient data.
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