You are the Director of HIM for an Integrated Healthcare Delivery System. Your chief medical informatics officer, Mary Watson, is creating a strategic plan for the new home care and skilled care services available in the system including the skilled care unit affiliated with the Flagship hospital, swing bed services offered by the three rural hospitals and the five nursing homes with skilled care beds that are part of your system. The system expects that there will be frequent transfers of patients and residents from one level of care to another within the system.

Assume that the rural hospitals either have a paper based record or do not have a sophisticated EHR.

There are various categories of standards that are important to HIM when looking at sharing of information between systems. 

1. Content exchange: These are standards that are used to exchange clinical information. These standards supply the specifications for exchanging information electronically. The standards indicate where each element occurs in an electronic file. That way an EHR from Hospital A can be shared with an EHR from Hospital B and elements such as date of birth, SSN, patient name and diagnosis, will be mapped to each other.
2. Vocabulary standards: This establishes common definitions for medical terms to encourage consistent descriptions of an individual's condition in the health record. For example, will we used myocardial infarction or heart attack as a diagnosis.
3. Transport of information standards: How will the data get from one system to the other. If one system is paper based, how will that paper information get into the EHR? How will the data get from Physician Office A to hospital B? What will we put in the record and what will we leave out?
4. Privacy and security standards: How will we ensure that PHI remains confidential and protected from unauthorized disclosure, alteration, or destruction? How will we ensure that only certain employees have access to information in the EHR when it can be viewed in many different location?

Of these, what are the most significant standards that Mary Watson needs to consider? Your outside reading discusses the challenges and barriers to interoperability. What are the barriers to exchanging information between the various components of the healthcare system that Mary has to consider. How can those barriers be turned into opportunities? Assuming that this merger is taking place sooner rather than later, what would your recommendation(s) be to Mary Watson that would allow for an efficient flow of information between the components of the healthcare system as it currently stands?