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An Interoperability Moonshot Proposal
Natalee Agassi1, Richard Schreiber2,3,4, Eric Pan5
1Oracle Health, California, United States, Redwoods City.
Applied Clinical Informatics
|June 24, 2026
Summary
Clinical data exchange is fragmented. A U.S. "moonshot" initiative proposes unifying terminology (SuperSNOMED) and accelerating Fast Healthcare Interoperability Resources (FHIR) for better data sharing.
Area of Science:
- Health Informatics
- Health Information Exchange
- Clinical Data Standards
Background:
- Clinical data exchange is fragmented, hindering coordinated and safe patient care.
- Despite technological advancements and regulatory efforts, interoperability improvements have been incremental.
- There is a critical need for unifying initiatives to enhance healthcare operations and outcomes.
Purpose of the Study:
- Identify persistent barriers to clinical data interoperability.
- Propose a U.S. national initiative to create a unified canonical clinical terminology (SuperSNOMED).
- Accelerate the adoption of Fast Healthcare Interoperability Resources (FHIR) and Implementation Guides (IGs) for improved data exchange.
Main Methods:
- Synthesized insights from expert roundtables and discussions.
- Appraised peer-reviewed and online evidence on standards, policies, and regulations.
- Identified barriers to interoperability implementation and developed policy recommendations.
Main Results:
- Identified five key barrier domains: fragmented terminology, overlapping standards, misaligned incentives, variable IG implementation, and insufficient funding.
- Proposed a national program with three pillars: SuperSNOMED, FHIR acceleration, and policy/governance.
- Recommended a 3-year plan with certification, workforce incentives, and data-quality safeguards.
Conclusions:
- Clinical data interoperability remains fragmented despite ongoing progress.
- This paper calls for a focused, funded, and well-governed national initiative.
- The proposed 'moonshot' aims to unify terminology and streamline data exchange standards.
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