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"A complete medical record is essential to reliable continuity of medical care. A complete highly structured, problem-oriented medical record will be invaluable to any physician and is essential to the busy one." 

—Published in March 1968 in the groundbreaking  New England Journal of Medicine article, “Medical Records That Guide and Teach

Dr. Lawrence Weed’s message is as resonant today as it was 51 years ago. The article remains one of the most frequently cited in the field of medical informatics, and it speaks to the moral imperative we have in healthcare to deliver the most complete and accurate patient record to physicians at the point of care.  

As an industry, we must implement solutions that enable successful data exchange so that patients can stop ferrying their medical records from treatment to treatment. We have the technology, interoperability standards, and clinical workflows to be better and ultimately provide better care to patients. Why? Because better care starts with interoperability.

Interoperability in healthcare enables different information technology systems to communicate and exchange usable data. This allows providers to have access to all data for a patient being treated.

Interoperability in healthcare is crucial, as new technological advances, healthcare organizations are not embracing connected health and interoperability ONLY to achieve a regulatory requirement—it is about improving patient outcomes. And, the level of growth is out-pacing what the healthcare industry experienced with electronic prescribing (e-prescribing) in Electronic Health Records (EHRs) several years ago. At that time, some pharmacies were participating, but quickly, almost full-adoption occurred. Today, the rush to gain connected health and interoperability is proving to be fierce.

A recent study, conducted by the Commonwealth Fund and published in the January 2020 issue of Health Affairs, found that a strong primary care system can help prevent illness, manage patient care across multiple providers, and reduce health care costs. Essential to such a system is effective interoperability and communication. To address patients’ needs, primary care physicians often must communicate and exchange information with specialists, hospitals and other care settings, social service providers—and, of course, the patients themselves. The study found the timely exchange of information between healthcare providers is “a central prerequisite for coordination.” 

Interoperability is more important now than ever

  • Data exchange benefits patients and physicians. Patients expect their doctor to have access to the full medical record—including hospital admissions, discharges, medication lists, lab tests and results, and care plans. When physicians have access to this data, they can make the best possible medical decisions and avoid duplicating tests and procedures.1 
  • Interoperability is real, and it is happening today at scale with practically every health Information Technology (IT) system. National networks have proliferated at an exponential scale. Direct messaging growth is surpassing the growth of ePrescribing. Between direct messaging, Carequality, and HIE connectivity, physicians can connect to practically any care setting. All of these services can be fully automated to exchange data based on defined trigger events such as the creation of a patient encounter or the completion of a referral visit.2  
  • Interoperability services can help reduce administrative costs for faxing and manual workflows while helping organizations improve office efficiency and reduce errors. Without interoperability, healthcare staff spends an inordinate amount of time faxing and manually coordinating data exchange. When staff is forced to manually abstract data from faxed documents, inadvertent errors can occur when entering that data into the EHR. Electronically exchanged data can be easily incorporated into the patient’s chart—minimizing errors and saving staff time while operating at an optimal, cost-effective level.3
  • Mitigating physician burnout. Physician burnout has been correlated to EHR inboxes that are swollen with tasks, messages, and documents to review. IT administrators can positively impact a physician’s experience by implementing routing rules and filters to minimize the number of tasks. They also can use NextGen Healthcare interoperability tools to read metadata of messages, analyze content, and determine the best recipient of the message—avoiding the provider’s inbox.4 

The four most important benefits of interoperability in healthcare

  • Transactional Data Exchange–allows for exchanging orders and results across care settings
  • Plug-and-play APIs–provide connection of NextGen® Enterprise EHR and Practice Management solutions to third-party applications and trusted services
  • Data aggregation tools–allow building longitudinal patient records across EHRs and healthcare facilities
  • National Interoperability Frameworks – enables connection to the largest group of providers and organizations anywhere in the U.S.

How Carequality fits into the picture

Health record exchanges are happening today in nearly every health system, EHR and care setting, and the industry has consolidated around Carequality.

Carequality is a public-private collaborative that facilitates an interoperability framework enabling seamless exchange between and among networks and is the preferred mechanism for secure data exchange across EHRs. Carequality provides seamless connectivity across all participating networks, and the adopters of the Carequality framework—as well as their clients—experience more rapid data delivery and cost-efficient health data sharing.   

NextGen Healthcare, a Carequality member, brokers more than 70 million health record requests per month; that is more than two million times per day that external systems ask for data for patients that NextGen Healthcare providers are treating. However, with this fast-paced shift to interoperability, there are still pain points, from a clinical focus, as well as a regulatory focus. 

One major issue faced by providers is determining where a patient has been previously treated. Other issues include:

• The quantity of available data may be overwhelming, especially if the content is not presented in a readable and ingestible manner

• Access to narrative text, dictated notes, and images is limited 

• Navigating administrative and business problems caused by regulatory requirements—and avoiding potential financial penalties 

How will these issues be overcome? Providers will benefit by implementing interoperability solutions that automate data exchange and enable it by default as a core element part of patient care. To solve the problem of locating historical data, Carequality enables organizations that provide record locator services, such as the Surescripts Record Locator and Exchange. Data quantity and quality issues can be addressed with smart filtering and routing rules similar to those implemented by NextGen Healthcare’s interoperability rules engine. 

With work going on in connected health and interoperability—including standards development, network proliferation, and patient access, I am very optimistic about the future. The real goals of interoperability will be achieved when patients no longer carry their medical records from one office to another; when providers have full usable access to every patient’s medical history; and when the topic of interoperability fades into the background as something that “just works.” 

To learn more , about interoperability and how Carequality addresses nationwide data sharing, register for an upcoming webinar.


1 Journal of General Internal Medicine, October 2019. Effect of Shared Electronic Health Records on Duplicate after Hospital Transfer.

2 KLAS Research. Interoperability 2018. Real Progress with Patient-Record Sharing via CommonWell and Carequality.

3 Applied Clinical Informatics. 2018. Feature and Function Recommendations to Optimize Clinician Usability of Direct Interoperability to Enhance Patient Care.

4 Ming Tai-Seale, Ellis C. Dillon, Yan Yang. “Physicians’ Well-Being Linked To In-Basket Messages Generated By Algorithms In Electronic Health Records.” Health Affairs, July 2019.



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Muhammad Chebli
Vice President, Solutions, NextGen Healthcare