Fri, 2011/08/12 - 9:00am

I. Background

In 1991, the Institute of Medicine (IOM) published a report which detailed a consensus vision for the creation of electronic medical records (EMR) in the U.S. (1) The report presented a number of high level objectives to guide EMR development including improving the quality of patient care, strengthening the scientific basis of clinical practice, and helping to control healthcare costs. The IOM predicted that computerization would lead to a radical transformation of the U.S healthcare delivery system if these goals were achieved.

A decade after this report was published, a follow-up report by the National Committee on Vital and Health Statistics (NCVHS) concluded that the predicted transformation had not taken place and provided an analysis of this failure. (2) The report identified the lack of interoperability and data comparability in healthcare information systems as the main reasons why the IOM goals had not been achieved. NCVHS defined interoperability as the ability of one computer system to exchange data with another computer system and described data comparability as the consistent interpretability of data when shared between computer systems.

II. The Importance of Semantic Interoperability

By addressing the need for interoperability and data comparability, semantic interoperability provides for the exchange of "meaning" between systems. It mandates the use of both a messaging standard and the codification of message data with a vocabulary standard so that the receiving computer system can predictably interpret the data being exchanged. (2) The data received in such an exchange are discrete pieces of information that can be used to trigger drug alerts, clinical decision support, or other knowledge tools in the recipient system.

Semantic interoperability is critical in facilitating health care delivery transformation because patient care typically involves a workflow comprised of related and dependent processes that cross institutional and computer system boundaries. (3) Without this level of interoperability, computerization leads to the creation of islands of electronic medical information which can only be accessed by a subset of those healthcare providers involved in the overall care of the patient. (4) Lack of semantic interoperability perpetuates the same problems of redundant data entry, unnecessary duplicate testing, and medical mistakes that are inherent to paper-based medical record systems.

Acknowledging the importance of semantic interoperability, it is critical to understand why semantic interoperability has been so difficult to achieve in healthcare information systems. The following articles in this series review the major barriers to semantic interoperability and explore potential solutions. 

  • Barrier #1: Lack of a master reference information model
  • Barrier #2: Limited collection of codified clinical data
  • Barrier #3: Limited use of controlled medical vocabularies 
  • Barrier #4: Technical challenges to providing data comparability
  • Barrier #5 Lack of a messaging standard which supports semantic interoperability


  1. Institute of Medicine. The Computer-Based Patient Record. An Essential Technology for Healthcare. National Academy Press. 1991.
  2. NCVHS. Uniform Data Standards for Patient Medical Record Information. Report to the Secretary. 2000.
  3. McDonald T, MD, Raiford RS, BSN, RN, BC, CPHIMS. Vocabulary Services and Their Role in Outcomes Improvements. ehealthrecordnews. 2002 Nov. - Dec. 2002;3(10):15-20.
  4. Duke JR, FHIMSS, MA, Crawford J, PhD. Terminology Services. ehealthrecordnews. 2002 Nov. - Dec. 2002;3(10):1 - 14.