Principles of Health Interoperability HL7 and SNOMED

The implementation of Universal Health Coverage (UHC) in the Philippines requires the formation of Local Government Unit (LGU)-centric Health Care Provider Networks (HCPNs). A cornerstone of this reform is the development of secure, scalable, and interoperable digital health ecosystems. However, significant challenges persist, including fragmented and non-standardized health information systems, siloed data repositories, and limited interoperability among Electronic Medical Records (EMRs) and Hospital Information Systems (HIS) particularly at the LGU level. This paper presents the design and deployment of the Smarter and Integrated Local Health Information System (SMILHIS), a Local Health Information Exchange (LHIE) platform developed to address these fragmentation issues. This work aims to support LGUs in deploying an LHIE platform that improves health data exchange, enhances continuity of care, and strengthens local health systems. Specifically, the objectives are to: 1. Deploy a modular, open-source LHIE platform that enables real-time health data interoperability across primary, secondary, and tertiary facilities within LGUs; and, 2. Implement an HL7 FHIR-based integration model aligned with the OpenHIE architecture and national interoperability specifications. The implementation of SMILHIS in three pilot LGUs-Municipality of Pulilan in Bulacan, Cagayan de Oro City, and Pangasinan Province demonstrated both the technical feasibility and operational value of deploying an interoperable LHIE platform. Each pilot considered different use cases: in Pulilan, the integration of health data with regulatory and treasury systems required reconciling heterogeneous data structures; in Cagayan de Oro, the absence of authoritative registries within the HCPN created barriers to unified patient tracking; while in Pangasinan, the scale and geographic dispersion of the health network complicated real-time health service visibility. Despite these challenges, the SMILHIS platform integrated patient, provider, and facility registries, facilitated secure data exchange across multiple systems, and provided real-time referral and facility capacity dashboards. The key outcome of the study was the demonstrated ability of LGUs to implement an interoperable, standards-based LHIE that significantly reduced data duplication, improved referral coordination, and strengthened health system responsiveness. In addition to enhanced technological capability, the study also showed notable improvements in LGU digital health governance. Moreover, it contributed to strengthening human resource capacity through hands-on implementation experience and multi-sector collaboration, while promoting greater alignment with national government digital health standards. These institutional and technical gains highlight SMILHIS as both a practical solution and a capacity-building mechanism for sustainable digital transformation at the local level.

This study provides an updated overview of primary care for children and adolescents across Europe, investigating how systems are evolving and identifying progress and persistent gaps in healthcare models, workforce challenges and digital health integration. This study draws implications for policy makers to improve the quality of paediatric care in Europe. A cross-sectional survey was conducted among national delegates of the European Academy of Paediatrics and the European Confederation of Primary Care Paediatricians. Respondents from 42 member countries provided standardised, national-level data on real-world implementation. Paediatrician-led, general practitioner-led, and combined models were reported in 28.6%, 26.2% and 45.2% of 42 countries, respectively. Eight countries (28.6%) changed their delivery models between 2010 and 2024, most transitioning toward combined care. Paediatricians' involvement declined with patient age, while general practitioners' involvement increased. Only 35.9% of countries achieved fully interoperable electronic health records. Preventive care delivery, adolescent health visits and training duration in primary paediatric care revealed critical gaps. Despite progress in care integration and digital uptake, major disparities remain for adolescents, digital infrastructure and training quality. Future paediatric primary care models must harmonise training, address regional disparities and invest in interoperable digital health systems to ensure equitable, high-quality care.

Pathways to interoperable electronic patient records in health and social care, Part 2: introduction for commissioners, chief clinical information officers and senior medical and social care leaders involved in health IT commissioning and strategy

In recent years, healthcare is evolving to meet the needs of a growing and ageing population. To support better and more reliable care, a comprehensive and up-to-date Personal Health Record (PHR) is essential. Ideally, the PHR should contain all health-related information about an individual and be available for sharing with healthcare institutions. However, due to interoperability issues of the medical and fitness devices, most of the times, the PHR only contains the same information as the patient Electronic Health Record (EHR). This results in lack of health-related information (e.g., physical activity, working patterns) essential to address medical conditions, support prescriptions, and treatment follow-up. This paper introduces the B-Health IoT Box, a fog IoT computing framework for eHealth interoperability and data collection that enables seamless, secure integration of health and contextual data into interoperable health records. The system was deployed in real-world settings involving over 4500 users, successfully collecting and transmitting more than 1.5 million datasets. The validation shown that data was collected, harmonized, and properly stored in different eHealth platforms, enriching data from personal EHR with mobile and wearable sensors data. The solution supports real-time and near real-time data collection, fast prototyping, and secure cloud integration, offering a modular, standards-compliant gateway for digital health ecosystems. The health and health-related data is available in FHIR format enabling interoperable eHealth ecosystems, and better equality of access to health and care services.

Why is there such an urgency to adopt health information technology (IT) interoperability standards? What does this urgency mean for nursing? It has been well documented that our health care system is in crisis. What worked in the past is no longer viable and must be improved. Despite spending over $1.6 trillion on health care as a nation, there are still serious concerns about high costs, avoidable medical errors, administrative inefficiencies, and poor coordination – all of which are closely connected to the failure to incorporate health IT into our health care system, according to the Agency for Healthcare Research and Quality.1 To address these concerns, numerous efforts have commenced which include setting a goal for the adoption of electronic health records (EHRs) recognition of interoperable health IT standards as part of the President’s National Health IT Agenda to lower cost and drive quality improvement, and the American Recovery and Reinvestment Act of 2009 (ARRA). Through these and other public/private efforts, the importance of advancing quality care and reducing costs through adopting interoperable health IT has been brought to the forefront of the nation’s efforts to improve the health care system.

BackgroundIn January 2009, the Social Security Administration (SSA) began a collaboration with MedVirginia to send authorized requests for and receipts of patient health information using the Medical Evidence Gathering and Analysis through Health IT (MEGAHIT) application. This request and receipt used the Nationwide Health Information Network (NwHIN) for secure and interoperable Health IT standards-based transport of patient information. MethodsThis case study, conducted from June to November 2009, represents the first production exchange of health information across the NwHIN. Interviews with 43 participants from a variety of organizations are reported across technical, organizational, and governance dimensions in terms of challenges, successes, and considerations for moving forward. ResultsThis case study reports on the technical, organizational, and governance dimensions of collaboration. In terms of technical success, the authorized medical evidence request and receipt took approximately 2min, including Continuity of Care Document (CCD) rendering. Overall, this resulted in mean case-processing time savings of 30%. Organizationally, the production effort required collaboration among multiple stakeholders: SSA sought claimant health information, MedVirginia provided patient health information, and other parties, such as the Office of the National Coordinator (ONC), facilitated transport of patient information across the NwHIN. According to those involved, this limited production effort tolerated and even benefited from an ad hoc multiparty governance structure. ConclusionsMulti-party collaboration can result in technical success, but achieving that success is dependent on a variety of organizational factors. This case study highlights the significance of and potential for requesting and receiving patient health information across the NwHIN. It will inform interested collaborating stakeholders as SSA engages additional providers in using MEGAHIT to collect health information via the NwHIN.

Heterogeneity and Interoperability in Local Public Health Information Systems.

ObjectivesTo inform initiatives to improve the interoperability of healthcare data, we described the experience of distinct phenotypes of physicians when obtaining information from outside sources.Materials and MethodsA total of 6175 family physicians across the United States responded to information technology questions on the 2022 and 2023 American Board of Family Medicine Continuous Certification Questionnaire (100% response rate). Latent class analysis grouped physicians by individual and practice characteristics and then compared reported experience with interoperability.ResultsA 4-class model (“Safety Net,” “Health System,” “Independent Practice,” and “Large Practice”) best fit. Health system and large practice physicians (predominately Epic users) were more likely to report information was integrated in their Electronic Health Record (EHR) than independent practice physicians (38% and 40%, respectively, compared to 24%), and to report that information from organizations using the same EHR was usable (52% and 51%, respectively, compared to 25%). Safety net physicians were least likely to report that information from outside organizations was usable (17% compared to 23% of independent physicians). Between 42% and 50% of each phenotype reported commonly encountering external records with a large volume of low-value information.DiscussionIndependent practice and safety net physicians reported worse experience in some dimensions of interoperability, likely driven by differences in access to information from organizations using the same EHR. Many other challenges were consistent across physician phenotypes.ConclusionInitiatives to improve interoperability among physicians may be most effective if targeted at independent practices and safety net practices; however, broad improvements will be necessary to address similar challenges across phenotypes.

It has been ten years since the publication of our first paper reporting on the beginning of a new national e- health interoperability journey in Australia and the interoperability framework developed by National e-health Transition Authority (NEHTA) [1]. Many new technologies, standard efforts and architecture approaches have emerged since then. Many new lessons were also learned by different stakeholders involved in using the framework as a basis for interoperability conversations and e-health solution development. Some of these were reflected in the second version of the NEHTA Interoperability Framework. This paper provides further details regarding this new version of the NEHTA Interoperability Framework, shows in more detail how Reference Model for Open Distributed Systems (RM-ODP) standards were used to provide underpinning foundations for interoperability, and lists some other development in e-health interoperability. Further, the paper describes the use of RM-ODP in other interoperability frameworks and describes links between interoperability frameworks, enterprise and solution architectures and interoperability methodologies.

Interoperability in public health has major advantages over agility gains throughout the state bureaucratic logistics system. This agility is fundamental to help relieve the highest demand in all areas of health sciences in the Brazilian public service. This short communication aims to inform the population of Amapa and the academic community about the implementation of interoperability of public health services in the state of Amapá. The service is already in its implementation phase and is expected to end and be fully used by early 2020.

Utilizing the fundamental characteristics of the decentralization, immutability, and transparency of blockchain technology, the healthcare industry has made notable advancements in incorporating it over the past five years. This review examines the progress and challenges encountered in this critical study by assessing 124 articles published by MDPI between 2018 and the current date. Examining blockchain’s potential uses, like safe data exchange and interoperability in supply chain management and electronic health records, provides exciting new directions for the future of healthcare. Blockchain technology can greatly increase efficiency and cost-effectiveness by guaranteeing data integrity, protecting patient privacy, and reducing administrative procedures. This paper objectively evaluates blockchain’s advancement in healthcare through a thorough analysis of real-world applications and research projects. By highlighting both its advantages and disadvantages, this analysis seeks to add to the continuing conversation about how blockchain will influence the way healthcare is managed and delivered in the future.

This chapter will provide an overview of InfoCentral, a virtual community platform launched for advancing digital health information in Canada. Developed and hosted by Canada Health Infoway, InfoCentral has become a hub and resource for stakeholders in digital health to discuss, consider, and evaluate common challenges among digital health system compatibility across the country (i.e., interoperability). A synopsis of the role Infoway contributes toward advancing Canadian digital health, the background and considerations for InfoCentral, along with a series of three flourishing virtual community case studies will be examined. Critical success factors and lessons learned in establishing, supporting and growing productive virtual communities conclude this chapter.

Evidence-based medicine relies on health data. Open health data initiatives need to be supported with data repositories that are optimized for searchability and discoverability. Five Canadian open health data repositories were evaluated for metadata-based searching, browsing, and navigational functionalities. In the different national, provincial and institutional open data repositories evaluated, the preliminary findings reveal the variability in these functionalities. This research will contribute to the development of guidelines and best practices for implementing metadata and searching and browsing functionalities for open health data repositories that will ultimately lead to a more interoperable open health data environment.

National privacy laws diverge between the European Union and United States, hindering transatlantic health data exchange and slowing AI-driven medical innovation. In response, the German Ministry of Health launched the pre-competitive Data for Health initiative, leading to the BRIDGE Pilot Study (2023-2025), a researcher-led effort to address this regulatory and legal gap. Using a mixed-methods approach, including structured surveys (n = 56 expert responses), ranking of steps via relative importance indexing, and 4 Delphi meetings, experts co-developed a practical framework composed of 30 steps in 3 consecutive phases for legally compliant and technically interoperable EU-US health data collaboration. The framework emphasizes early data protection assessments, secure transfer protocols, and iterative governance checks. The final consensus framework provides a stepwise guide to navigate regulatory and legal complexities and operationalize cross-border research. Ongoing input from researchers and stakeholders will help ensure the framework remains adaptable and provides a clear, scalable foundation for cross-border health data exchange.

In 2016 and onward, computable medical records will fuel the next generation of EHRs, as the quest for interoperable, portable, and comprehensive health data continues. Computable medical records, readable by both human and machine, will house a patient’s entire record from conception to death. Importantly, such records will declare their fidelity level — their degree of completeness and accuracy — so that users can not only identify what data is there, but also what’s missing. The computable medical record will be unique, enabling users to find the right record for the right person; will support a health status scoring system; and will ideally be open source to drive adoption across software vendors, hospital systems, and government.