The document discusses challenges with achieving semantic interoperability in health information systems. It outlines current standards used like SNOMED CT but notes that systems often fail to use available standards. Barriers include a lack of centralized terminology, too many standards, and vendors behind on adopting standards. To improve semantic interoperability, the document suggests requiring use of standards, building partnerships to create a centralized translation system, and learning from EU projects that defined priority use cases.

1. Interoperability Critique
Overview
According to HIMSS Board, semantic interoperability is the ability of two or more
systems exchange information and use the information that has been exchanged. Semantic
interoperability allows caregivers to electronically exchange the patient summary and use that
information adequately to improve quality, safety, and efficiency. The Office of National1
Coordinator for Health Information Technology released “Connecting Health and Care for the
Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0” that proposes critical
actions that the public and private sector need to take to move toward an interoperable health
information technology ecosystem over the next 10 years. Health information technologies are
creating a lot of opportunities to improve health outcomes including patient quality and safety
while lowering the associated costs to health care. True interoperability and the exchange of2
health information can support benefits for payers, patients and providers. This can be achieved
through well defined standards and semantic interoperability. If the systems that will be
exchanging the information are not using available standards, semantic interoperability is more
difficult to reach.
Current State
The ONC has adopted several vocabulary and terminology standards and are required in
the 2014 CEHRT definition and meaningful use stage 2. The vocabulary and terminology
1
​HIMSS. What is Interoperability? Retrieved from
http://www.himss.org/library/interoperability-standards/what-is-interoperability
2
​Dixon, B. E., Vreeman, D. J., & Grannis, S. J. (2014). The long road to semantic interoperability in support of public health:
Experiences from two states. ​Journal of Biomedical Informatics​ , 49, 3-8.

2. standards include the Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT)
for problems and/or conditions, for medications and medication allergies the standard is
RxNorm, for laboratory tests the standard is the Logical Observation Identifiers Names and
Codes (LOINC) and for immunizations the standard is CVX. HL7 v2 messages and C-CDA are
embedded within implementation guidelines The ONC is using various information models and
representations of the data directly referenced to the semantic standards and formats choose.3
The ONC in the critical actions for consistent data formats and semantics establishes that
provider and patient-facing technology developers need to update the systems to available
standards such as C-CDA 2.0. In addition, ONC establishes that SDOs will advance and
accelerate semantic standards for lab orders and other priorities that are required to update for
pilot developments.
Challenges
The data produced come from different sources and are not stored in a centralized system
or database. The scientific community suggested the use of the semantic web technologies to
create an interoperability framework between health information systems and integrate data from
different sources. Dixon (2013) says: “in two states suggests that operational clinical4
information systems often fail to use available standards, a barrier to semantic interoperability”.
In a letter from the American Health Information Management Association (AHIMA) to the
ONC in April 2, 2015, the association submitted several comments around the Nationwide
Interoperability Roadmap DRAFT Version 1.0. In the area of interoperability, the AHIMA
3
​The Office of National Coordinator for Health Information Technology. “Connecting Health and Care for the Nation: A Shared Nationwide
Interoperability Roadmap Draft Version 1.0”. 2015. Page 79. Retrieved from
https://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.0.pdf
4
​Kolias, V. D., Stoitsis, J., Golemati, S., & Nikita, K. S. (2014). Utilizing Semantic Web Technologies in Healthcare. In
Concepts and Trends in Healthcare Information Systems (pp. 9-19). Springer International Publishing.

3. commented that the Roadmap is lacking a clear approach and methodology for enabling
interoperability. There is no definition of business and functional requirements for
interoperability. Other are important associated to semantic interoperability is the certification
and testing and the AHIMA recommends a better collaboration with NIST and the IHE to define
the conformance criteria for testing using CDA standard for data exchanges. 5
Too many standards, diverse data sources, lack of centralized terminology and ontology
translation service, HL7 v.2 limitations, vendors and providers that are behind schedule in terms
of standards, and lack of collaboration contribute to reduce the probability to achieve semantic
interoperability.
Suggested Path
Dixon (2013), defines potential strategies to improve semantic interoperability. As
mentioned in the AHIMA comments to the ONC Roadmap, Dixon too establishes that the United
States lacks of a complete strategy to leverage standardized vocabularies that are necessary to
have a complete semantic interoperability in health IT systems. The options to improve semantic
interoperability are the following: a) required data senders to use standards, b) public health
solely responsible for translation, and c) a strategic, cooperative approach between data sharing
partners. 6
Because reaching semantic interoperability is difficult of too many variables, my
suggested approach is to require data senders to comply with the use of standards, build a
cooperative approach between data sharing partners to build a centralized system or entity that is
5
AHIMA. AHIMA comments on Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap
DRAFT Version 1.0. April 3, 2015. Retrieved from
https://www.healthit.gov/sites/default/files/comments_upload/ahima_comments-onc_roadmap_final_040215.pdf
6
​Dixon, B. E., Vreeman, D. J., & Grannis, S. J. (2014). The long road to semantic interoperability in support of public health:
Experiences from two states. ​Journal of Biomedical Informatics, 49, 3-8.

4. solely responsible for the translation in a private-public partnership. In addition, as
recommended by the AHIMA, consider the EU experience in defining Use Cases from
nationwide perspectives to select the priority uses cases. EU Antilope project from 2013 to 2015
focused on the dissemination on on the adoption of the eHealth European Interoperability
Framework. The project defined a list of use cases including medication, radiology, laboratory,
patient summary, referral and discharge reporting, participatory healthcare, telemonitoring and
multidisciplinary consultations.
References:
AHIMA. AHIMA comments on Connecting Health and Care for the Nation: A Shared
Nationwide Interoperability Roadmap DRAFT Version 1.0. April 3, 2015. Retrieved from
https://www.healthit.gov/sites/default/files/comments_upload/ahima_comments-onc_roadmap_fi
nal_040215.pdf
Dixon, B. E., Vreeman, D. J., & Grannis, S. J. (2014). The long road to semantic interoperability
in support of public health: Experiences from two states. ​Journal of Biomedical Informatics, 49,
3-8
HIMSS. What is Interoperability? Retrieved from
http://www.himss.org/library/interoperability-standards/what-is-interoperability
Kolias, V. D., Stoitsis, J., Golemati, S., & Nikita, K. S. (2014). Utilizing Semantic Web
Technologies in Healthcare. In ​Concepts and Trends in Healthcare Information Systems (pp.
9-19). Springer International Publishing
The Office of National Coordinator for Health Information Technology. “Connecting Health and
Care for the Nation: A Shared Nationwide Interoperability Roadmap Draft Version 1.0”. 2015.
Page 79. Retrieved from
https://www.healthit.gov/sites/default/files/nationwide-interoperability-roadmap-draft-version-1.
0.pdf