Putting health record interoperability standards to work

This paper provides a snapshot of the current interoperability standards landscape and investigates how different standards are adopted in different jurisdictions. The aim is to provide useful insights for decision makers by looking from a wider angle to include political, social and business drivers rather than taking a purely technical approach. Semantic interoperability, which is a major bottleneck to achieving eHealth systemic interoperability, is dependent on terminology, content and messaging standards. In particular, the architectural aspects of content and messaging standards seem to be critical and currently the subject of many heated debates. A considerable amount of effort into international harmonisation is underway and evidence shows that it may be possible to use different standards and yet still be able to accomplish semantic interoperability. It is recommended that a careful analysis be performed to seek evidence, rather than relying on hearsay, for determining how each standard fulfils certain requirements depending on the context. An environmental scan and literature survey highlights the fact that making a good choice of standards depends on what outcomes are desired, and usually involves selection of a number of different standards to be applied together. It is to be noted that, non-technical aspects of standards, such as acceptance, feasibility of implementation or availability of expertise, are as important, and determine what is achievable. The paper concludes by presenting a number of options which include combinations of standards and also provides insights for the evaluation and selection process.