EHR Interoperability Stakeholders Facing 5 Major Challenges

By Sara Heath

– As the push for EHR interoperability continues, non-federal initiatives continue to face several challenges.

EHR interoperability challenges health information exchange standards

A recent Government Accountability Office (GAO) report reviews these challenges, indicating that universal standards may be necessary to continue with efforts for interoperability.

The 18 non-federal agencies GAO consulted with reported many of the same challenges faced when facilitating EHR interoperability, including insufficient health data standards, variation in health data privacy rules, patient record matching, costs, and a need for governance.

Insufficient health data standards

GAO found that many interoperability initiatives do not utilize specific health data standards. This means that different EHR systems are using different formats and terminology to exchange information, seriously stunting interoperability. GAO suggests that once health data standards are made adequately specific and are adhered to universally, interoperability will increase amongst all EHR platforms.

Variation in health data privacy rules

EHR interoperability and information exchange is also limited because of standards governing each state’s handling of health data privacy. Because some states have more stringent policies, not all health information can be exchanged from state to state. Further hindering the process is the fact that these policies are not uniform. While an EHR may access certain information in one state, it may not be able to access that same kind of information in another, creating a complicated web of data sharing.

Because of this difficulty, many EHR interoperability initiatives have concerns about violating health data privacy rules by inadvertently sharing information that is prohibited from being shared.

Difficulty matching patient records

Many interoperability stakeholders report difficulty matching patient records across EHR systems because there is no standard method for identifying a patient. For example, many practices identify a patient using name and date of birth; however, there may be another patient in another EHR with that same information. This could cause physicians to access the incorrect patient file.

Patient matching criteria also poses challenges because different practices identify patients using different criteria. For example, one practice may identify a patient using his or her name and date of birth, and another with the patient’s Social Security number. The health information exchange process may be hampered because the first practice does not collect Social Security number, and therefore cannot identify the patient information from the second practice.


Some providers may also be hindered by the costs of EHR interoperability. This is because a practice’s EHR must be customized to become interoperable with other EHRs and because a practice must employ the proper legal actions to protect itself when exchanging health data.

Lack of governance amongst entities

Governance and trust amongst entities is a critical component in creating EHR interoperability, the GAO report finds. Governance practices can help establish health information standards, privacy standards, and technical standards, as well as address other issues industry stakeholders are facing. However, the report acknowledges that it is difficult to establish trust amongst entities, and that creating these governances may be hard because certain entities may face conflicting organizational policies.

The GAO report found that a major component in moving forward with interoperability initiatives is creating provider buy-in. This means encouraging providers to see the importance and value in fostering EHR interoperability and health data exchange. According to the report, this can be accomplished by customizing EHRs with features that practitioners specifically find valuable and that improve their workflows, and by incentivizing pay with quality performance, encouraging practitioners to value the importance of their EHR.


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