Health information exchange standards and their implications for public health

(1) Background: Health information exchange (HIE) is complicated and the standards that support them are abundant. The landscape is confusing, in part because the subject matter itself is complex. Requirements for Meaningful Use as well as public health programmatic objectives necessitate the use of interoperable standards to facilitate those transactions. (2) Objective/purpose: To describe the current state of HIE standards, and how public health can play a part in their creation and use. (3) Methods: HIE projects and the State, regional and organizational levels have begun implementing projects using national standards. This is a key component to ensuring interoperability of data both within and between projects. Public health agencies exchanging data with the clinical community have begun to embrace these standards and use them to achieve a more interoperable health data environment. (4) Results: A number of standards areas will be discussed, including technical standards (structure and syntax as well as transport), semantic standards (terminology and coding), and process standards (workflow and context). Detailed examples of these standards will be provided including information related to standards development and harmonization initiatives. Finally, a set of high-profile national organizations and Federal initiatives that are attempting (each in their own way) to compile disparate standards into more useable forms will be discussed. Examples of standards in use from different HIEs will also be provided. (5) Discussion/conclusions: Public health agencies have a lot to gain from participation in standards development and harmonization to keep public health at the forefront of HIE activities. While much progress has been made, public health agencies have a long way to go in adopting standards for data interoperability.