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ONC Data Brief Charts Impressive Increases in Healthcare Interoperability

Analysis  |  By Eric Wicklund  
   January 27, 2023

The number of hospitals improving their EHR platforms to enable data sharing, especially from outside sources, has more than doubled since 2017, according to a report from the HHS Office of the National Coordinator for Health IT (ONC).

The number of hospitals improving their technology base to promote interoperability has more than doubled in the past five years, according to a new data brief from the Health and Human Services Department's Office of the National Coordinator for Health IT.

The ONC brief, which details interoperability advances from 2017 through 2021, also found that hospitals have improved the availability and use of their electronic health record platforms to accept data from outside sources, and half of the nation's rural hospitals now have information electronically available at the point of care.

"Hospitals’ rapid improvements in interoperability could be attributed in part to the initial implementation of health IT provisions from the ONC Cures Act Final Rule (Cures Rule) and adoption of 2015 Edition certified technology," the ONC brief, prepared by Yuriy Pylypchuk and Jordan Everson, says. "The Cures Rule updated the Health IT Certification Program to include new and updated criteria and standards that will advance interoperability. Nearly 90% of hospitals have adopted 2015 Edition certified technology and are well positioned to adopt these new and updated criteria and standards."

"Other data show that a large majority of hospitals have already done so," it continues. "Additionally, 74% of hospitals adopted the bulk data export capability, as of 2021. The most common uses of bulk data export were for analytics and reporting (63%) and population and health management (35%), and, less so, for switching EHRs (12%)."

Among other findings in the report:

  • Health information service providers (HISPs) and health information exchanges (HIEs) remain the most common methods used by hospitals for electronically sending and receiving summary of care records.
  • More than 60 percent of hospitals have used an HIE to to electronically query or find patient information from external sources.
  • Hospital participation in CommonWell Health and the Sequoia Project's Carequality increased significantly between 2018 and 2021.
  • significantly between 2018 and 2021.

An appendix to the report listed the top barriers to exchanging health information. They include:

  • One partner in the exchange doesn't have an EHR or other electronic system to receive data.
  • Difficulty in matching or identifying the correct patient between systems.
  • Challenges of exchanging data across different vendor platforms.
  • Difficulty in finding a provider's Direct address.

"Policy activities that support cross-network exchange such as Trusted Exchange Framework and Common Agreement (TEFCA) will help reduce the number of different networks and methods that hospitals need to use to support exchange," the brief says. "Other provisions of the Cures Rule are being implemented now to help hospitals shift from simply establishing connectivity to optimizing and simplifying the use of multiple methods of exchanging information. However, some barriers to information exchange remain prevalent. For instance, 48% of hospitals reported one-sided sharing relationships in which they share patient data with other providers who do not in turn share patient data with the hospital."

"Given that a majority of hospitals (74%) reported the ability to integrate information into their EHRs, current policy efforts could increase the value of that integration," Pylypchuk and Jordan Everson conclude. "For instance, recent actions were taken to improve the quality of data from external sources by advancing the use of specific data elements, such as through the United States Core Data for Interoperability (USCDI), and through the required use of standardized application programming interface (API) technology using the HL7 Fast Healthcare Interoperability Resource (FHIR). Efforts such as these should help ensure that information is available, integrated into the EHR, and used at the point of care – all of which have further room for improvement and will ultimately drive improvements in care and secondary use of data, such as for research."

Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, Telehealth, Supply Chain and Pharma for HealthLeaders.


The ONC's latest data brief details advances and challenges in healthcare interoperability from 2017 to 2021.

The brief notes that more than six in 10 hospitals now engage in key aspects of electronically sharing health information and integrating summary of care records in the EHR, a 51% increase since 2017.

Overall, the percent of hospitals with information available at the point of care jumped 22% from 2017 to 2021, and more than half of all rural and small hospitals now have this capability.

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