1. Raiford, Robin BSN, RN-BC, CPHIMS, FHIMSS
  2. Sensmeier, Joyce MS, RN-BC, CPHIMS, FHIMSS

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Background: Make no mistake about it-this country is on a mission. The mission, set forth by the President, is to have "an interoperable EHR for most Americans by 2014[horizontal ellipsis]to improve the quality and efficiency of healthcare." So you hear the term "interoperable" a lot, but you might not totally understand the profound impact of "semantic interoperability."


Current Problem: For years, there have been unresolved issues involving technical and semantic interoperability of healthcare information systems. This has stemmed from lack of a standardized vocabulary among clinical information systems. For more than 50 years, healthcare delivery has centered around the "visit," with a focus on what is happening to the patient only in today's visit or at the current admission. To be sure, there have been old records, but did anyone ever actually read them, to say nothing of comparing the data with the current visit.


Current Federal Initiatives: Giant strides are taking place in the HIT market with regard to HL7V3, clinical document architecture (CDA), continuity of care document (CCD), and Integrating the Healthcare Enterprise (IHE) profiles and actors. There is momentum like never before since the department of Health and Human Services (HHS) created the American Health Information Community (AHIC) and contracts were won by the Healthcare Information Technology Standards Panel (HITSP). These are feeding into the requirements for the Certification Commission for Healthcare Information Technology (CCHIT) to accomplish the mission.


Cornerstones of Semantic Interoperability: The cornerstones of achieving semantic interoperability at last involve discussing IHE profiles, SNOMED, LOINC, HL7 V3, CDA, CCD, and ultimately certification by CCHIT, making sure that vendors comply with the mission of "an interoperable EHR for most Americans" by 2014[horizontal ellipsis]to improve the quality and efficiency of healthcare."


Impact: Semantic interoperability has huge implications for nurses who waste so much time asking patients questions they have answered 100 times before, but about which the data were not shared. When semantic operability is achieved between providers and between visits, nursing will be validating information, not collecting it for another round of redundant data entry. Nurses actually will have access to information from the previous visit including the patient's problems, medications, allergies and history before they ever see the patient.