Improving outcomes with interoperable EHRs and secure global health information infrastructure.

One of the central pieces for healthcare and public health is information. Through the shared use of the Information Super Highway and the WWW, for example, elder patients can, and indeed are "visited, diagnosed, treated and managed" from their homes, with the help of telemedicine systems. These technologies also provide society with additional benefits within a global health perspective, with applications ranging from disease prevention and genetics to surveillance and epidemiologic studies. For example, discoveries relating to the prevention or curing of a disease in one part of the world should be "known" everywhere else instantaneously. During an emergency, individuals travelling the world should be able to access their healthcare records for proper care, anywhere. Individuals emigrating from a country to any other should be able to use their information "seamlessly" in terms of the "old" and "new" information systems, no matter where they are. The information contained in multiple systems, i.e., civilian, military forces, etc., should appear transparently among all. However, at this time, significant questions regarding privacy of health information, quality of the services delivered and in general, the information assurance, i.e., authenticity, confidentiality, integrity, availability, and non-repudiation persists. A common aspect to information protection and sharing is interoperability. The authors believe that this term is poorly understood and consequently its incorrect use generates immensely negative consequences. The question raised by the authors then is, what is "true interoperability"?