BEYOND INTEROPERABILITY STANDARDS: ADDRESSING FRAGMENTED DATA EXCHANGE IN U.S. HEALTHCARE THROUGH INTEGRATED GOVERNANCE-DRIVEN AND SCALABLE HEALTH INFORMATION EXCHANGE FRAMEWORKS

Digitization of the United States healthcare system has increased the use of the electronic health records as well as improved the data systems, but smooth data exchange is still a challenge. Although the interoperability standards like Health Level Seven and Fast Healthcare Interoperability Resources have been adopted, healthcare data remain fragmented among institutions limiting care coordination and data-driven decision-making. This work provides an assessment of the shortcomings of the existing interoperability strategies and offers a method of health information exchange that is governance-based and scalable and incorporates technical, organizational and policy aspects. The review indicates that even though interoperability standards allow data exchange in a structured and application programming interface format, their success is limited to inconsistent implementation, poor enforcement, and limited practical integration. The institutional silos, inconsistencies in regulations, distrust, and misaligned incentives have continued to cause fragmentation. The review pinpoints the key missing factor in governance, which is roles of policy harmonization, frameworks of trust, and alignment of incentives. It also points out that new technologic systems like federated systems, cloud computing, artificial intelligence, and blockchain can improve scalability when they are backed up by robust governance systems.