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Interoperability Progress and Remaining Data Quality Barriers of Certified Health Information Technologies


The Consolidated Clinical Document Architecture (C-CDA) is the primary standard for clinical document exchange in the United States. While document exchange is prevalent today, prior research has documented challenges to high quality, effective interoperability using this standard. Many electronic health records (EHRs) have recently been certified to a new version of the C-CDA standard as part of federal programs for EHR adoption. This renewed certification generated example documents from 52 health information technologies that have been made publicly available. This research applies automated tooling and manual inspection to evaluate conformance and data quality of these testing artifacts. It catalogs interoperability progress as well as remaining barriers to effective data exchange. Its findings underscore the importance of programs that evaluate data quality beyond schematron conformance to enable the high quality and safe exchange of clinical data.


Interoperability of medical data is essential to improve care quality and efficiency. It has been identified as necessary for clinical innovation and critical to open electronic health records (EHRs). Value-based care models rely on information sharing to properly function and the US federal government has focused recent attention on advancing interoperability.

Over the past decade in the United States, significant interoperability progress has been made. Today, a majority of hospitals and physicians can electronically share data and…

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