DISCUSSION 1 According to HIMSS , interoperability “describes the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.” There are four levels of interoperability: foundational structural semantic organizational Foundational interoperability: the ability of one I.T. system to send data to another I.T. system. The receiving I.T. system does not necessarily need to be able to interpret the exchanged data — it must simply be able to acknowledge receipt of the data payload. This is the most basic tier of interoperability. Structural interoperability: “the uniform movement of healthcare data from one system to another such that the clinical or operational purpose and meaning of the data are preserved and unaltered,” HIMSS states. In order to achieve structural interoperability, the recipient system should be able to interpret information at the data field level. This is the intermediate level of interoperability. Semantic Interoperability: the ability of health I.T. systems to exchange and interpret information — then actively use the information that has been exchanged. Semantic interoperability is the highest level of interoperability.“Semantic interoperability takes advantage of both the structuring of the data exchange and the codification of the data, including vocabulary so that the receiving information technology systems can interpret the data,” stated HIMSS. Achieving semantic interoperability allows providers to exchange patient summary information with other caregivers and authorized parties using different EHR systems to improve care quality, safety, and efficiency. This level of interoperability allows healthcare organizations to seamlessly share patient information to reduce duplicative testing, enable better-informed clinical decision-making, and avoid adverse health events. Effective health data exchange can also help to improve care coordination, reduce hospital readmissions, and ultimately save hospitals money.   “New” Organizational (Level 4) – includes governance, policy, and social. While semantic interoperability is the goal, most healthcare organizations are still working to establish foundational and structural interoperability. Hospitals and health systems can utilize existing health data standards to achieve lower levels of interoperability and set a solid foundation for future improvements in health data exchange. Evaluate one of the Interoperability levels listed above. Include the following aspects in the discussion: Using your text and other      course resources, assess one of the following levels listed above and its      importance in achieving full interoperability. Discuss technical and      economic barriers hospitals face in achieving your chosen level of      interoperability. Explore the role the    .

1. DISCUSSION 1
According to
HIMSS
, interoperability “describes the extent to which systems and
devices can exchange data, and interpret that shared data. For
two systems to be interoperable, they must be able to exchange
data and subsequently present that data such that it can be
understood by a user.” There are four levels of interoperability:
foundational
structural
semantic
organizational
Foundational interoperability: the ability of one I.T. system to
send data to another I.T. system. The receiving I.T. system does
not necessarily need to be able to interpret the exchanged data
— it must simply be able to acknowledge receipt of the data
payload. This is the most basic tier of interoperability.
Structural interoperability: “the uniform movement of
healthcare data from one system to another such that the clinical
or operational purpose and meaning of the data are preserved
and unaltered,” HIMSS states.
In order to achieve structural interoperability, the recipient

2. system should be able to interpret information at the data field
level. This is the intermediate level of interoperability.
Semantic Interoperability: the ability of health I.T. systems to
exchange and interpret information — then actively use the
information that has been exchanged. Semantic interoperability
is the highest level of interoperability.“Semantic
interoperability takes advantage of both the structuring of the
data exchange and the codification of the data, including
vocabulary so that the receiving information technology systems
can interpret the data,” stated HIMSS.
Achieving semantic interoperability allows providers to
exchange patient summary information with other caregivers
and authorized parties using different EHR systems to improve
care quality, safety, and efficiency.
This level of interoperability allows healthcare organizations to
seamlessly share patient information to reduce duplicative
testing, enable better-informed clinical decision-making, and
avoid adverse health events.
Effective health data exchange can also help to improve care
coordination, reduce hospital readmissions, and ultimately save
hospitals money.
“New” Organizational (Level 4) – includes governance, policy,
and social. While semantic interoperability is the goal, most
healthcare organizations are still working to establish
foundational and structural interoperability.
Hospitals and health systems can utilize existing health data
standards to achieve lower levels of interoperability and set a
solid foundation for future improvements in health data

3. exchange.
Evaluate one of the Interoperability levels listed above.
Include the following aspects in the discussion:
Using your text and other course resources, assess one of the
following levels listed above and its importance in achieving
full interoperability.
Discuss technical and economic barriers hospitals face in
achieving your chosen level of interoperability.
Explore the role the government plays in your chosen level.
Share suggestions as a health care leader to support the
development of your chosen level.
REPLY TO 2 OF MY CLASSMATES DISCUSSION TO THE
ABOVE QUESTIONS AND EXPLAIN WHY YOU AGREE.
MINIMUM OF 150 WORDS EACH
Classmate’s Discussion 1
Foundational interoperability involves the close organization
and teamwork of diverse investors, including patients,
providers, and health information technology (I.T.)
professionals. Yet, the U.S. healthcare delivery system remains
to have a culture defined by owners, where data have become
more of a product and inexpensive profits than a basis for
organized care. According to (Interoperability and the
Connected Health Care System | CMS, n.d.) There have been
many accusations over foundational interoperability issues with
I.T. systems accused of "information blocking" or purposely

4. tampering with the flow of information between different I.T.
systems. Foundational interoperability often intimidates vendors
into accepting and using certain HIMSS, rather than enabling
collaboration across these technologies (Healthcare
Interoperability: 3 Top Barriers| Kanda Software, n.d.).
Healthy foundational interoperability can enable organizations
to gain abilities by collaborating with government enterprises to
promote efficient patient services (Interoperability and the
Connected Health Care System | CMS, n.d.). As a result, the
government plays a role in better healthcare opportunities and
economic development opportunities. In addition, foundational
interoperability that involves the government is essential for
companies that work together and exchange intellectual
business relationships. The government, therefore, establishes
vigorous foundational interoperability that can directly benefit
the economy to enable better-informed clinical decision-making
and safer healthcare practices.
All healthcare facilities must accept foundational
interoperability because that's the only way in which they can
achieve their goal of sending data to another I.T. system.
Developing patient data will enable me to provide healthcare
without delays as a healthcare leader. Although the data comes
in different levels, I can also support the development of
foundational interoperability by using the proper clinical
decisions. As a healthcare leader, I must consider the patient's
medical records as not their possession but that of the patients.
Healthcare interoperability: 3 top barriers and how to overcome
them
. Kanda Software. (n.d.). Retrieved October 23, 2022, from
https://www.kandasoft.com/healthcare-interoperability-3-top-
barriers-and-how-to-overcome-them/
Interoperability and the Connected Health Care System

5. . CMS. (n.d.). Retrieved October 23, 2022, from
https://www.cms.gov/blog/interoperability-and-connected-
health-care-system
DISCUSSION 2
Information blocking poses a threat to the benefits of EHRs and
health I.T. The Office of the National Coordinator for Health
Information Technology (ONC) describes information blocking
as the intentional and unreasonable blocking of health
information among health I.T. systems. This practice does not
include the blocking of information for health data privacy
reasons or because of reasonable barriers. Federal
organizations, including The Centers for Medicare & Medicaid
Services (CMS) and ONC, have increased pressure on providers
and health I.T. companies still engaging in information
blocking. In addition to
federal policies
, incentive programs also underscore the importance of putting
an end to information blocking. As part of the Merit-Based
Incentive Payment System (MIPS) under the Quality Payment
Program (QPP), providers must attest to the
prevention of information blocking reporting
requirements. There are several actions ONC and other federal
agencies can take to address certain aspects of the information
blocking problem.
These actions include:
Proposing new certification requirements that strengthen
surveillance of certified health I.T. capabilities “in the
field.”
Proposing new transparency obligations for certified health
I.T. developers that require disclosure of restrictions,

6. limitations, and additional types of costs associated with
certified health I.T. capabilities.
Specifying a nationwide governance framework for health
information exchange that establishes clear principles about
business, technical, and organizational practices related to
interoperability and information sharing.
Working with the Centers for Medicare & Medicaid Services
to coordinate health care payment incentives and leverage
other market drivers to reward interoperability and exchange
and discourage information blocking.
Helping federal and state law enforcement agencies identify
and effectively investigate information blocking in cases
where such conduct may violate existing federal or state
laws.
Working in concert with the HHS Office for Civil Rights to
improve stakeholder understanding of the HIPAA Privacy
and Security standards related to information sharing.
Reflect on ways to prevent Information blocking.
Include the following aspects in the discussion:
Choose one of the actions to address the information
blocking problem
Choose an aspect not already chosen by a peer
Find two scholarly recent (less than three years) references
about your chosen action

7. Summarize the action and explain how it can help with
solving the issue
Discuss the reasons why providers and vendors are still
engaging in information blocking and the impact on patient
outcomes
REPLY TO 2 OF MY CLASSMATES DISCUSSION TO THE
ABOVE QUESTIONS AND EXPLAIN WHY YOU AGREE.
MINIMUM OF 150 WORDS
Classmate’s Discussion 2
2009 Health Information Technology for Economic and Clinical
Health (HITECH) Act was passed by Congress. HITECH offered
financial incentives providers and hospital systems to improve
the interoperability of their systems. Essentially, HITECH gave
money to providers, hospitals, and hospital systems if they
made health information exchange easier (this excludes
confidential information). This allows vendors, the creators of
health information technology, to increase their revenue by
charging higher process for more electronic health information
(EHI) technology that meets the compliancy standard. In
addition, vendors may also increase earnings by decreasing the
interoperability so that they can charge higher prices for EHI
systems. Research indicates that 50% of Electronic Health
Record vendors actively participate in information blocking.
While only, 25% of hospitals actively engage in information
block and another 34% admit to blocking information
occasionally (J. Alder-Milstein, 2017).
Interoperability impacts the safety of patients. Interoperability
decreases lab and radiology tests, decreases duplicate
procedures thus increasing patient safety and curbing the
economic burden of health care (N. Menachemi, 2018).

8. Action and References
Pat research noted that 91% surveyed vendors, providers,
hospitals, and hospital systems noted that clear national laws
(nationwide governance framework) pertaining to
interoperability and data sharing would be either very effective
or moderately affective. According to my research, a multi-tier
approach could be the gold standard in the future. In addition,
mandatory comparing of vendor products, prohibiting the gag
clause and encouraging the public to report when there are
issues is estimated to be 93% effective. Lastly, legislation
requiring vendors to demonstrate their products interoperability
to potential IT clients is estimated to be 92% effective (J.
Alder-Milstein, 2017). The current lack of inoperability has
proven that anything less than a multi-tier approach will not be
effective.
Summary and Explanation of Action
Medicare Access and CHIP Reauthorization Act of 2015
(“MACRA”) attempted to provide a legal framework for
providers and hospitals that were reimbursed through the
Medicare system (a subset of the population). On a larger scale,
The Cares Act was passed by Congress which penalizing and
prohibited information blocking. The Office of the National
Coordinator for Health Information Technology (“ONC”) and
the National Institute of Standards and Technology, stating that
both public and private entities must work together to support a
framework (C. Knooth, 2020). With the framework in place, the
remaining steps of prohibiting the gag clause and encouraging
the public to report issues are the remaining steps according to
research (J. Alder-Milstein, 2017).
References

9. C. Knooth, G. S. (2020, May 27). Can Electronic Health
Records Be Saved?
American Journal of Law and Medicine, 46
(1). doi:https://doi.org/10.1177/0098858820919552
J. Alder-Milstein, E. P. (2017, March 7). Information Blocking:
Is It Occurring and What Policy Strategies Can Address It?
Milkbank Quarterly, 95
(1), 135. doi:10.1111/1468-0009.12247
N. Menachemi, S. R. (2018, September). The benefits of health
information exchange: an updated systematic review.
Journal of the American Medical Informatics Association, 25
(9), 1259-1265. doi:https://doi.org/10.1093/jamia/ocy035