Because exchange is a prerequisite for interoperability, here at ONC we’ve focused a lot of attention on it. Our early work with the NwHIN pilots emphasized secure, query-based exchange (using something called Web Services) in which one system asked (or queried) another system for information. The DIRECT project defined a secure, email-based exchange system in which one system pushed information to another system. And both web-services and email-based exchange are part of the 2014 edition of the certification rule that we issued last August.
But we must always remember that exchange is only part of the puzzle. If I send an email from one computer to another computer, I have exchanged information between those two systems. But if I write my message in French, (and you can only speak English), there is no way for you to automatically use the information that has been exchanged without risking losing something in translation. Similarly, if I use DIRECT to send a scanned office visit report from one EHR to another EHR, I may have exchanged information, but I won’t be able to seamlessly use the information in the new system to alert the provider automatically of a new drug allergy, for example. So to get to health information interoperability, we need more than just transport standards: we must also use standards for vocabularies and terminologies (to help standardize the meaning of the words that we use), standards for structure (so computers know how to break a message into the appropriate information chunks), and potentially other kinds of standards (but more on that later).
Health information exchange is important – it is a vital part of modernizing our health care system. But health information exchange is not the same as health information interoperability. Transport standards are important to achieving health information exchange, but they will not get us to true interoperability unless we continue our work developing the full set of standards needed to support interoperability.
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