The Legislative History of Healthcare Interoperability

Written by Lacey Jackson on April 18, 2019

Posted in Ebooks + Guides, Healthcare

This year we’ve seen the Office of the National Coordinator (ONC), the Centers for Medicaid and Medicare (CMS), and the Department of Health and Human Services (HHS) as a whole make significant pushes for nationwide healthcare interoperability. By March 2019, ONC had released their highly anticipated proposed rule, which pushes for further interoperability using the MyHealthEData initiative.

As we know, this isn’t a new trend.

While the shift from paper-based health records to EHRs has been most significant in recent years, healthcare interoperability has been an ongoing source of frustration for patients and providers. Since 2004, federal officials have been pushing to advance interoperability.

The initial push resulted in the creation of the Office of the National Coordinator via executive order as a way to coordinate major health IT stakeholders, build a list of standards, and promote health information exchange. Congress brought an official structure to the ONC in 2009 with the Health Information Technology for Economic and Clinical Health (HITECH) Act. In addition to HITECH, Congress enacted the American Recovery and Reinvestment Act (ARRA) in 2009, which—among many other industry-changing factors—obligated healthcare providers to switch from paper to electronic health records.

Congress followed up the HITECH Act with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA took the first step in creating a federal definition for interoperability and directed the Secretary of the HHS to create metrics to measure milestones and achievement in nationwide interoperability. These metrics measured the number of providers making strides in the following areas:

  1. Electronically sending, receiving, finding, and integrating health information from outside sources
  2. Using electronic information from outside sources in clinical decision-making  

But policy to promote EHR adoption and interoperability efforts didn’t end with MACRA. The 21st Cures Act was officially passed by Congress in 2016 to continue the journey started by HHS and ONC towards interoperability.

healthcare interoperability

Since, HHS, CMS, and ONC have continued to roll out new rules to strengthen or weaken aspects of previous policies to ultimately further the goal of achieving a nationwide interoperable healthcare system.


We took a deep dive into healthcare interoperability, its history, and what changes need to be made to achieve it in our 2019 Healthcare Interoperability Guide. If you’d like to learn more about how Formstack can help your organization achieve interoperability, you can access our free guide today.