One´s definition of interoperability shapes the size and scope of the problem and thus the response in terms of policy, resources and priorities (by Ed Larson) [1]

there is little that most people want from health care for which health care information exchange and interoperability (HIEI) isn’t a prerequisite. [4]

Technical Interoperability

The focus of technical interoperability is on the conveyance of data not on its meaning
contains all of the structure, names and medico-legal information required for an EHR extract to be represented faithfully on receipt even if the nature of the clinical content have not been "agreed" in advance. [5]

version information, patient name, security information, etc. focus not on clinical knowledge even though it can be sent along to. Medical-content is not agreed on equivalent to unstructured data.


functional, syntactic, exchange
structural interoperability?
are these real synonyms?

Semantic Interoperability

Ability of information shared by systems to be understood.

Process Interoperability

Required for successful system implemenation into actual working settings
-> Filtering, Summarization and alert triggers
Could be comparable to co-operability mentioned by Kalra and Blobel in their paper [5]



Pro and Cons of EHR


  • Without interoperability, EMR adoption will further strengthen the information silos that exist in today’s paper-based medical files, resulting in even greater proprietary control over health information and, with it, control over patients themselves [4]
  • Consumers can move more easily between and among clinicians without fear of their information being lost. Payers can benefit from the economic efficiencies, fewer errors, and reduced duplication that arise from interoperability [4]
  • interoperability is to bind together a wide network of real-time, life-critical data that not only transform health care but become health care.
  • protect patient privacy

Why HIEI didn´t take off yet

  • interoperability benefits are highly dispersed across many stakeholders
  • the last to install an interoperable EMR benefits from everyone else’s prior investment, and the first to install bears most of the cost.
  • interoperability first movers have faced many barriers and challenges that have resulted in partial success, slow progress, and outright failure


1. Coming to Terms: Scoping Interoperability for Health Care
Health Level Seven EHR Interoperability Work Group; February 7, 2007 Patricia Gibbons et al. Good summary of 100 different interoperability definitions \\\daten\projekte\ELGA\Literatur\interoperability\Coming to Terms February 2007.doc
2. Towards Semantic Interoperability for Electronic Health REcords
S. Garde, P. Knaup, E. J. S. Hovenga, S. Heard \\\daten\projekte\ELGA\Literatur\interoperability\Towards Semantic Interoperability for Electronic Health REcords - MIM 2007.pdf
3. Semantic integration in healthcare networks
Richard Lenza, Mario Beyer, Klaus A Kuhn \\\daten\projekte\ELGA\Literatur\interoperability\Semantic integration in healthcare networks - IJMI 2007.pdf
4. interoperability: The Key To The Future Health Care System
David J. Brailer emphazises the choice american citizens have. -> choice leads to fragmentation -> Fragmentation, in turn, results in errors, duplication, lack of coordination First EMR or first interoperability??? \\\daten\projekte\ELGA\Literatur\Interoperability\The Key To The Future Health Care System David J. Brailer 2005.docx
5. semantic Interoperability of EHR Systems
Kalra, Bloebl co-operability is mentioned as the ultimate level of interoperability. \\\daten\projekte\ELGA\Literatur\Interoperability\Semantic Interoperability of EHR Systems - 2007.pdf
6. The Value Of Health Care Information Exchange And Interoperability
By Jan Walker, Eric Pan, Douglas Johnston, Julia Adler-Milstein, David W. Bates, and Blackford Middleton 77 billion dollars could be safed a year if HIEI is implemented fully \\\daten\projekte\ELGA\Literatur\Interoperability\The Value Of Health Care Information Exchange And Interoperability Jan Walker 2005.docx
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