Understanding EHR Interoperability Challenges and How To Overcome Them

EHR Interoperability Challenges

Healthcare systems worldwide are increasingly moving toward digitization, with Electronic Health Records (EHRs) being at the forefront of this trend. EHRs promise to streamline processes, enhance patient care, and enable robust data analysis. However, one of the significant challenges lies in achieving EHR interoperability – the seamless sharing of patient information across different health systems. 

According to a survey by the Office of the National Coordinator for Health Information Technology (ONC), about 50% of hospitals often or sometimes experience challenges exchanging patient health information across different platforms. With this comes a host of challenges, ranging from data privacy concerns to issues of standardization and compatibility. This article seeks to unravel these challenges and provide solutions to overcome them.

Data Standardization: Harmonizing Disparate Systems

Challenge: Data standardization, or the lack thereof, represents one of the most formidable obstacles to EHR interoperability. Healthcare organizations use various EHR systems with unique data input standards, leading to a lack of uniformity. The disparate systems can result in inconsistencies, misinterpretations, or errors, hindering smooth data exchange and impacting patient care quality. 

Healthcare providers often deal with different medical terminologies and coding systems, such as LOINC for lab tests and SNOMED CT for clinical terms, leading to potential confusion. Additionally, how one system records patient demographics or medical histories may significantly vary from another. For example, while one EHR might use a simple yes/no field to record smoking status, another might use a text field, leading to discrepancies in how the data is captured and interpreted.

Solution: One key to overcoming this challenge is adopting universal healthcare data standards. Standards like Health Level Seven (HL7) and Fast Healthcare Interoperability Resources (FHIR) provide frameworks for exchanging, integrating, sharing, and retrieving electronic health information. These standards can guide healthcare providers on how data should be formatted and exchanged between systems, promoting interoperability.

Another strategy is implementing healthcare data dictionaries or controlled medical vocabularies, which ensure all stakeholders have a common understanding of the healthcare terms used. These provide a single source of truth, which reduces the risk of misinterpretation and promotes consistency.

Lastly, healthcare organizations can work with EHR developers that specialize in data-cleansing tools and services. These solutions help identify and rectify inconsistencies, redundancies, and errors in the data, promoting data accuracy and reliability. 

Data Privacy and Security: Safeguarding Sensitive Information

Challenge: The exchange of healthcare data across different EHR systems and healthcare organizations invariably raises questions about data privacy and security. Every data exchange point presents a potential vulnerability for unauthorized access or data breaches. In an era where cyber threats are increasingly sophisticated and commonplace, maintaining the security of sensitive patient health information is paramount.

Moreover, different jurisdictions have different regulations regarding data privacy. Healthcare providers often find themselves in a bind trying to comply with varied and frequently changing privacy laws. This regulatory labyrinth makes the task of achieving EHR interoperability even more challenging.

Solution: A robust, multi-faceted security strategy is essential for ensuring data privacy and securing EHR data during exchanges. Healthcare organizations need to leverage advanced security technologies and practices, such as encryption, secure user authentication, regular security audits, and intrusion detection systems, to fortify their defenses.

To navigate the complex terrain of data privacy regulations, healthcare providers could employ compliance management systems or seek the expertise of compliance officers. These measures can help track regulatory changes and ensure that data exchange practices are in line with the most current laws.

Privacy-by-design, an approach where privacy measures are incorporated into technology designs from the outset, can also play a vital role. Potential vulnerabilities can be identified and addressed proactively by considering privacy and data protection issues during the design phase.

System Incompatibility: Bridging the Technical Divide

Challenge: Technical incompatibility between different EHR systems is another significant hurdle to achieving interoperability. EHR systems are often designed with a specific workflow in mind, which can vary widely across different healthcare providers. Furthermore, proprietary EHR systems may not be designed to interact with other systems, making data exchange challenging.

The use of legacy systems, which are older software or hardware that may not be compatible with newer technologies, further compounds this problem. These systems may lack the necessary interfaces to enable interoperability or may not be able to support the data formats used by newer EHR systems.

Solution: Implementing health information exchange (HIE) standards like HL7 and FHIR can help bridge the gap between different EHR systems. These standards define how data should be formatted and transferred, fostering greater compatibility between systems.

Upgrading or replacing legacy systems can also alleviate technical incompatibility issues. While this may involve significant upfront costs, the long-term benefits in terms of improved interoperability and enhanced patient care make it a worthwhile investment.

Furthermore, middleware technologies can serve as a bridge between different EHR systems, translating data from one format to another. These software layers sit in the middle of other applications, facilitating communication between systems that would otherwise be unable to interact.

High Cost of Interoperability: Breaking Down Financial Barriers

Challenge: Achieving EHR interoperability can be a costly endeavor. These costs arise from upgrading or replacing existing systems, implementing new interfaces, conducting rigorous testing, and providing staff training. Additionally, ongoing maintenance costs to ensure the interoperability remains effective can be substantial. These costs can be prohibitive for many healthcare providers, particularly smaller organizations or those in resource-poor settings.

Solution: While the initial costs of achieving interoperability can be high, the long-term benefits often outweigh these expenses. Enhanced interoperability can lead to improved efficiency, better patient care, and reduced healthcare costs in the long run. Therefore, viewing interoperability as an investment rather than an expense is crucial.

Seeking financial incentives provided by government programs can help offset some of the costs. For example, the Promoting Interoperability Program in the United States offers financial incentives to healthcare providers who demonstrate meaningful use of certified EHR technology.

Additionally, partnering with a trusted technology vendor who can offer scalable solutions can help manage costs. Such vendors can provide tailored solutions that fit a healthcare organization’s budget and specific needs, mitigating the need for substantial upfront investment in new systems.

Lack of Standardization: The Need for a Unified Language

Challenge: The need for more standardization in health data is a major impediment to EHR interoperability. Without a standardized set of data elements and a common language, data exchange between different EHR systems can become a game of ‘lost in translation.’ 

Health data is inherently complex, consisting of various types of information, including diagnoses, treatment plans, imaging data, lab results, and more. Each of these data types can be recorded and represented differently across various EHR systems, making it difficult to accurately interpret and use the data.

Solution: The adoption of standardized healthcare terminologies, such as LOINC for lab results and SNOMED CT for clinical terms, can help achieve a common language across different EHR systems. These coding systems ensure that the same medical terms are consistently used, reducing ambiguity and enhancing the accuracy of data interpretation.

Healthcare providers can also play a role by advocating for greater standardization and being actively involved in standards development initiatives. By bringing their practical experience and insights to the table, healthcare providers can help shape standards that are both clinically relevant and practical for implementation.

Implementing interoperability is a complex and challenging journey, but the potential benefits make it a worthwhile pursuit. The road to full interoperability may be long, but each step forward brings us closer to a future where seamless, real-time health data exchange becomes a reality.


EHR interoperability challenges are multi-faceted, encompassing technical, financial, and regulatory obstacles. However, healthcare providers can take significant strides toward achieving this goal by implementing robust security strategies, adhering to standardized healthcare terminologies, upgrading legacy systems, and viewing interoperability as an investment.

While the journey toward full EHR interoperability is complex, it’s not a journey you must embark on alone. Arkenea, with its deep industry knowledge and technical expertise, can guide you through the maze of EHR interoperability. Our team is well-versed in developing HIPAA-compliant, interoperable EHR systems that can seamlessly integrate with your existing workflows, improving the efficiency and quality of patient care. Let Arkenea be your trusted partner in your journey toward EHR interoperability.