Healthcare IT insiders regard interoperability as the key to effective health information exchange, and some might say, the hardest to pin down thus far. Industry leaders agree there can be no true exchange without interoperability. How can healthcare transformation occur unless doctor A's EHR can process the information received from doctor B's EHR?

John W. Loonsk, MD, chief medical officer at CGI Federal, served as director of interoperability and standards in the Office of the National Coordinator for Health IT (ONC) from 2005 to 2009.

He is among many who pin the "elusive" tag on interoperability.

"For those in the trenches, interoperability is still an uphill grind if not largely elusive," he writes in a recent Healthcare IT News commentary. "They just aren't seeing many health IT systems that can easily process information that other systems provide." 

Health information exchange is making some progress, he said, "But without broader exchange and the interoperability needed to process 'foreign' information, health IT can actually act to increase the unnecessary information that a provider has to review rather than help make the provider more efficient."

Loonsk has observed a new degree of pessimism when it comes to interoperability, he says, noting that some have suggested (before Congressional committees) that true interoperability is a decade away.

ONC chief Farzad Mostashari, MD, acknowledges that interoperability has been a tough nut to crack. But, he remains optimistic. 

"Most vendors really do see it now as part of their self-interest to be as interoperable as possible," he says, adding that Stage 2 of meaningful use raises the bar. "It's a huge step up," he says, "a huge step up on interoperability."

Mostashari views EHR interoperability as a shared responsibility among the vendors, hospitals and doctors, and the government.

Customers (hospitals and physicians) must demand interoperability, Mostashari says. 

"If the vendor doesn't seem committed to interoperability, he advises, "You should look elsewhere because the future of healthcare is going to be the need to coordinate."

Mostashari does not say when interoperability might be achieved, instead quotes his colleague, Doug Fridsma, MD, director of ONC's Office of Science and Technology: "Interoperability is not a destination, it's a journey." 

"There's always going to be new needs, new requirements for interoperability," Mostashari explains. "We're going to constantly have to keep stepping up towards greater and greater levels of being able to share information and understand the information once it's shared."

Also, as Fridsma explains in his commentary (see page 29), "There are two parts to the definition of interoperability: the ability of two or more systems to exchange information and the ability of those systems to use the information that has been exchanged."