Defining interoperability in healthcare
At its root, the word interoperability means “the ability of a system to work with or use the parts or equipment of another system.”1 In some ways, interoperability can be thought of like a foreign language translator. Language translators take words and information in one language and make them comprehensible to those who understand a different language; this process allows an exchange of information to occur.
In healthcare specifically, interoperability relates to the ability of different healthcare systems to exchange, interpret, and apply shared data, despite having different systems that understand different languages.
For example, if a patient goes to a clinic to see their primary care provider, and that provider refers the patient to an external specialist, it is ideal for the specialist to have access to the documentation and test results that were done by the primary care provider.
That’s where interoperability comes in. Interoperability allows the patient’s data to be securely exchanged and formatted in a way that the specialist understands, despite the two providers having disparate HIT systems and structures.
It is important, though, to distinguish the difference between interoperability and integration. While integration is about joining many systems into one, interoperability is about allowing many diverse systems to stay diverse but still exchange data together.
Interoperability allows for more flexibility than integration because it is scalable with fewer limitations, while integration creates more rigidity. Thus, interoperability is the growing focus and future of health data exchange.
The four levels of interoperability
True interoperability in healthcare can only be achieved when all four levels of interoperability are addressed. These four levels create conditions that ensure an exchange has understandable and secure data.
- Foundational Interoperability - Foundational interoperability ensures that information flows electronically between senders and receivers. Sending lab results or imaging via secure messaging is an example of foundational interoperability.
- Structural Interoperability - Also sometimes referred to as syntactic interoperability, structural interoperability is concerned with how data is formatted and exchanged. Structural interoperability ensures that data is organized consistently for exchange. Standards set by Fast Healthcare Interoperability Resources (FHIR) help create this consistency across systems. However, this stage does not yet ensure comprehensible data.
- Semantic Interoperability - Semantic interoperability is where data is standardized and codified to ensure receiving systems can understand and use transferred data. This vital step makes sure uniform vocabulary is used between the sending and receiving systems. For example, providers may document differently, with one physician noting ‘patient C/O lower abdominal pain,’ while another writes out ‘patient complains of lower abdominal pain’ in their notes. Interoperability at the semantic level ensures that each system can interpret the same information and translate it for the correct output. To do this, providers and systems must follow standardized vocabularies, such as SNOMED CT, ICD-10-CM, and RxNorm.
- Organizational Interoperability - Organizational interoperability is concerned with governance, policies, and trust frameworks. Health information exchange (HIE) frameworks ensure successful interoperability by building guidelines that help providers, plans, and individuals securely access data. The most common HIE framework is the Trusted Exchange Framework and Common Agreement (TEFCA). Organizational interoperability is vital for building trust with patients, establishing credibility, maintaining compliance, and supporting collaboration across networks.
Why interoperability matters in healthcare
Despite the intricacies of achieving it, interoperability in healthcare has multiple benefits for patients, providers, and practices.
For patients, interoperability helps them receive high-quality, safe care. When care teams get the full picture of a patient’s health via health data exchange, they can make more informed decisions. It also minimizes the risk of inefficiencies such as duplicate testing, which can inhibit care continuity and impact patient experience. More data also typically leads to fewer errors, which is critical for patient safety.
Providers also enjoy faster clinical decision-making, care coordination, and care delivery with streamlined data. This simultaneously helps minimize burdens and alleviates clinical frustration.
Interoperability in healthcare, in turn, supports practice success by supporting administrative staff, meeting compliance, and strengthening financial outcomes.
Challenges to achieving interoperability
While there are vast benefits to interoperability in healthcare, there are also many burdens to implementing and achieving it.
Technical challenges are common, especially between legacy and modern applications. More outdated systems struggle to communicate with more modern technology. Returning to our metaphor that interoperability is like a language translator, technical challenges stem from the fact that applications may speak the same language with different dialects, leading to miscommunications.
This also plays into semantic difficulties, which is when clinical terminologies or vocabularies don’t perfectly match up, causing details to get lost in translation. Even with standardized vocabulary, minor inconsistencies and discrepancies with items such as medication lists can lead to gaps.
Another challenge is organizational, which is when different departments’ applications operate independently from one another, even those within the same hospital system. Aligning operations can be a complicated process, typically hindered by leadership buy-in, stakeholder agreement, and gaining trust across organizations or institutions.
Underlying all these issues is the need to meet compliance and security requirements, adding an additional layer to interoperability efforts.
Preparing for the future of interoperability
Regulatory compliance and data standards are arguably the most important factors for organizations to prioritize as they prepare for the future of interoperability in healthcare.
FHIR standardization is where many healthcare organizations have moved and will continue to move as new government regulations require the adoption of FHIR. Thus, especially for organizations that receive payments for Medicare or Medicaid services, adoption will become an integral part of their strategy.
The 21st Century Cures Act is another prominent consideration, as it mandates EHR interoperability and prohibits information blocking. This is to ensure that patients can access and share their data easily.
Achieving interoperability and following guidelines is especially vital since organizations that fail to do so may be penalized financially. Additionally, it can open them to data security risks and ineligibility for reimbursements under certain healthcare models.
How NextGen Healthcare supports interoperability
NextGen Healthcare is committed to staying ahead of regulatory requirements while delivering connected care and compliant interoperability. Mirth Connect delivers secure, real-time data exchange across disparate systems, meeting the demands of high-volume and high-throughput workloads.
Through NextGen Healthcare’s integration with Mirth Connect, users can leverage a user-friendly interface that tackles organizational silos, saves costs, and integrates with mobile. One client, Bahia Software, applied Mirth Connect to meet the patient data exchange needs for more than 70 hospitals and specialty clinics.
Interoperability in healthcare: Looking ahead
Interoperability in healthcare is, and will continue to be, an ongoing advancement across the industry. Building a strong interoperability infrastructure with an integrated EHR can help organizations drive better workflows and care coordination.
If you’re interested in learning how NextGen Healthcare solutions support FHIR, TEFCA, and future interoperability requirements, contact us at mirthconnectsales@nextgen.com to talk with a member of our team today.
1 Merriam-Webster.com Dictionary, s.v. “interoperability,” accessed January 6, 2026, https://www.merriam-webster.com/dictionary/interoperability.
