1. McCartney, Patricia PhD, RNC, FAAN

Article Content

The vision of health information technology (HIT) has always championed the potential to share information among patients and care providers; the right information, to the right person, at the right time. This potential for health information exchange depends on "interoperability" or in colloquial terms, "computers that talk to each other." Interoperability is the ability of systems to exchange and use electronic health information from other systems without special effort on the part of the user (Office of the National Coordinator for Health Information Technology [ONC], 2015c). Yet as patients, we navigate among multiple patient portals separately owned by our providers, pharmacies, and insurers. As caregivers, we navigate among multiple clinical systems for patient medical records, documentation, pharmacy, laboratory, diagnostics, and administrative information, even within a single healthcare entity. And, evidence confirms that simultaneously opening these multiple system screens on a single workstation is a safety risk. In 2014, a majority of hospitals sent and received a summary of care document, but less than half of hospitals actually integrated any received data into the patient's record (ONC, 2015b). Interoperability remains a work in progress.


The ONC describes the HIT interoperability vision and progress as a "shared nationwide interoperability roadmap" (ONC, 2015b). The actualization of this vision requires ongoing public and private sector partnerships to develop policies and technical actions, including core technical standards. The ONC released the 2016 Interoperability Standards Advisory (ISA), a report of consensus on the best available federally recognized interoperability standards and implementation specifications for industry to use in meeting clinical interoperability needs (ONC, 2015a). Interoperability needs are what clinicians want to achieve with interoperability. The report outlines technical characteristics for vocabulary, code sets, and terminology, and is a guideline for industry.


There are measures of progress in interoperability for nursing. The 2016 ISA Section IV: Projected Additions to ISA, based on needs suggested by stakeholders responding to the call for comments, includes four new proposed nursing categories: Nursing Assessments, Nursing Outcomes, Nursing Problems, and Nursing Interventions & Observations. These categories align with longstanding nursing efforts toward standardized nursing language. The American Nurses Association (ANA, 2014) promotes standardized representation and accurate capture of nursing knowledge, care, and contributions to patient outcomes in all vendor clinical information systems; not only for the benefit of patient outcomes but also to enhance nurse work satisfaction. The ANA asserts that clinical systems should be interoperable within and among all vendors' products.


The concentrated pace and demands of daily nursing practice can be a barrier to appreciating progress in the wider vision of interoperability. In 2016, ONC will begin the process for the 2017 ISA and invite comments. Explore and reach out to the nursing voices who respond to these federal calls for comments and recommendations; ANA, American Academy of Nursing Expert Panel on Informatics and Technology, and Healthcare Information and Management Systems Society Nursing Informatics.




American Nurses Association. (2014). Standardization and interoperability of health information technology: Supporting nursing and the national quality strategy for better patient outcomes. Retrieved from[Context Link]


Office of the National Coordinator for Health Information Technology. (2015a). 2016 Interoperability standards advisory. Retrieved from[Context Link]


Office of the National Coordinator for Health Information Technology. (2015b). Connecting health and care for the nation: A shared nationwide interoperability roadmap. Retrieved from[Context Link]


Office of the National Coordinator for Health Information Technology. (2015c). Interoperability. Retrieved from[Context Link]