Healthcare Interoperability: What Cardiology Needs to Know

Last updated: July 14, 2026

Key Takeaways

• Healthcare interoperability eliminates fragmented CIED data workflows across multiple manufacturer portals and reduces manual data entry.
• The four levels of interoperability, Foundational, Structural, Semantic, and Organizational, show why most legacy OEM exports fail to deliver actionable clinical data.
• Interoperability gaps create patient safety risks through alert fatigue and cause practices to miss revenue from CPT codes such as 93298, 93299, and 99454.
• Regulatory mandates including TEFCA, FHIR R4, and USCDI v3 now require cardiology platforms to support standardized data exchange and governance policies.
• Rhythm360 unifies multi-vendor CIED data with AI-powered triage and bi-directional EHR integration.

The Four Levels of Interoperability in Healthcare

HIMSS defines four levels of healthcare interoperability: Foundational, Structural, Semantic, and Organizational. Each level builds on the one before it.

Level 1, Foundational: Systems can exchange data, but the receiving system cannot interpret the content. A PDF of a device transmission sent via secure email is a foundational exchange. The data moves, but a clinician must manually extract values.

What this means for cardiology practices: Most legacy OEM portal exports operate at this level. A technician receives a PDF report and must manually transcribe arrhythmia burden, battery status, and therapy counts into the EHR. This process is slow and prone to error.

Level 2, Structural: Data is exchanged in a standardized format, such as an HL7v2 message, that the receiving system can parse into defined fields.

What this means for cardiology practices: Structural interoperability lets a platform ingest HL7 feeds from an EHR or OEM API and place data into the correct fields automatically. Without it, every new device manufacturer requires a custom manual workflow.

Level 3, Semantic: Sender and receiver interpret data identically using standardized vocabularies such as LOINC, SNOMED CT, and ICD-10. Semantic interoperability remains the central challenge due to heterogeneity, lack of consensus, and unstructured data.

What this means for cardiology practices: Without semantic interoperability, an atrial fibrillation burden value from one OEM may carry a different label than the same value from another. That mismatch breaks automated alert triage and clinical decision support logic.

Level 4, Organizational: Governance, policies, legal frameworks, and social considerations enable secure, seamless, and timely data exchange across competing institutions. Regulatory pushes such as the 21st Century Cures Act and TEFCA are driving adoption toward Level 4, yet about 70% of hospitals sometimes or often engage in all four domains of interoperable exchange, while far fewer do so routinely.

What this means for cardiology practices: Participation in TEFCA-aligned networks and compliance with the Information Blocking Rule now require organizational-level interoperability, including documented data governance policies and FHIR API support. Platform selection has become a compliance decision, not just a workflow preference.

The Clinical and Financial Cost of Fragmented Data

Fragmented data is a patient safety risk and a financial liability, not just an inconvenience. Many cardiac device transmission alerts carry no clinical relevance, and this noise causes alert fatigue that leads clinicians to miss the events that matter. Device clinics process high volumes of transmissions annually, and many have seen their device populations grow substantially, which compounds the bottleneck.

The clinical stakes are direct. Andrew Beaser, MD, Associate Professor of Medicine at the University of Chicago Medicine, described pre-implementation workflows as "a major challenge and incredibly difficult." After implementing a unified platform, his team found: "We are able to address these issues earlier; rather than waiting for a 3-month visit, we can call patients in for evaluation."

On the financial side, the lack of a centralized system for tracking billable events causes missed revenue and rejected claims for remote monitoring CPT codes such as 93298, 93299, and 99454. Gaurav A. Upadhyay, MD, FACC, FHRS, Director of the Pacing & Defibrillation Device Clinic at the University of Chicago Medicine, confirmed: "We have improved billing and accountability for our patients after the integration."

See how Rhythm360 turns fragmented OEM data into a single source of truth.

These clinical and financial stakes are exactly why regulators have stepped in. Three frameworks now govern interoperability requirements for cardiology practices in 2026.

Healthcare Interoperability Standards

FHIR R4 has reached near-universal adoption, driven by a federal mandate that every certified EHR vendor expose FHIR R4 APIs. That mandate already shows up in practice: 90% of health systems have FHIR-enabled APIs, and 81% of U.S. non-federal acute care hospitals enabled patient access to health information via APIs in 2024. Building on this momentum, every new EHR deployment in 2026 must demonstrate FHIR R4 API support aligned to USCDI v3.

USCDI v3 became the baseline as of January 1, 2026, requiring certified health IT to support all 94 data elements. USCDI v4 was finalized and published in July 2023, adding data classes for health insurance, tribal affiliation, and social determinants of health. TEFCA requires all 94 USCDI v3 elements for compliance, which makes these expansions directly relevant to remote monitoring data exchange.

The Information Blocking Rule is now actively enforced, with penalties up to $1 million per violation. HHS escalated enforcement in September 2025, and that escalation raises the stakes for OEM portals that restrict data portability. Cardiology practices relying on those proprietary portals face direct compliance exposure under this rule.

What Interoperability Looks Like in Practice

Real-world interoperability in cardiology takes several forms, and each one maps to a specific CIED data challenge.

• API-based OEM data ingestion: A vendor-neutral platform connects directly to manufacturer APIs, pulling structured transmission data without manual portal logins. This structural-level exchange eliminates redundant staff effort.
• HL7 bi-directional EHR integration: Normalized CIED data flows into Epic, Cerner, or Athenahealth automatically, and signed reports write back to the patient record, closing the loop between device monitoring and the clinical chart.
• PDF parsing via computer vision: When an OEM does not offer a structured API, AI-powered optical character recognition extracts values from unstructured PDF reports and maps them to standardized fields, bridging foundational and semantic interoperability.
• TEFCA-aligned network exchange: By March 2026, 600 million health records had been exchanged through TEFCA, enabling care coordination across competing health systems. This is the organizational-level interoperability that supports transitions of care for CIED patients.

These examples show real progress, but significant gaps remain across the industry.

Why CIED Data Still Falls Through the Cracks

Clinicians must manually aggregate CIED data from multiple vendors and care settings because traditional EHRs are not well suited for this data type. A March 2026 survey of health system CIOs found that necessary data remains siloed across disconnected systems. Only 16% reported that their core EHR systems currently support vendor-agnostic interoperability.

At the semantic level, each CIED manufacturer uses proprietary nomenclature to describe similar device features, so the same arrhythmia event may carry different labels across systems. 80% of physicians feel that a lack of data sharing between systems contributes to increased stress levels, according to athenahealth's 2025 Physician Sentiment Survey.

Staffing compounds the problem. Gaurav A. Upadhyay, MD, at the University of Chicago Medicine, noted: "Staffing was always an issue for our center, because our device clinic, like many other medical centers, had struggled with technician turnover and timely weekend coverage."

TEFCA and FHIR Progress Through 2026

TEFCA went live in December 2023 with the designation of Qualified Health Information Networks (QHINs). 11 QHINs have been designated since then. Exchange volume grew from 10 million records in January 2025 to nearly 500 million by February 2026 and 600 million by March 2026. Mariann Yeager, CEO of The Sequoia Project, stated: "TEFCA is going from being in development mode to implementation rollout. We saw tremendous growth in 2025."

The CMS interoperability framework, established in July 2025, is a voluntary framework under which participating entities may provide or facilitate access to data. For cardiology practices, this means EHR systems must now support structured CIED data exchange via FHIR, which raises the floor for what a compliant remote monitoring platform must deliver. Andrew Beaser, MD, at the University of Chicago Medicine, observed: "Decision support, including AI-assisted decision support, will become increasingly important as data volumes grow."

These regulatory shifts raise a practical question: how does a platform actually close these gaps? Rhythm360 was built to answer it.

How Rhythm360 Closes the Interoperability Gap

Rhythm360 by RhythmScience is a cloud-based, HIPAA-compliant platform built to resolve the interoperability gaps cardiology practices face daily. It ingests data from all major CIED manufacturers, including Medtronic, Boston Scientific, Abbott, and Biotronik, via API, HL7, XML, and PDF parsing through computer vision, normalizing disparate formats into a single structured record. This approach addresses all four interoperability levels at once: secure connectivity at the foundational level, standardized field mapping at the structural level, consistent terminology at the semantic level, and documented governance for TEFCA-aligned exchange at the organizational level.

The platform's AI-powered alert triage filters out clinically non-actionable transmissions and surfaces only prioritized events. It achieves an 80% reduction in alert fatigue while maintaining 99.9% data reliability. Bi-directional EHR integration with Epic, Cerner, Athenahealth, and eClinicalWorks ensures signed reports write back to the patient chart automatically. Automated CPT documentation captures billable events for codes including 93298, 93299, and 99454, recovering revenue that fragmented workflows routinely leave unclaimed. A secure, HIPAA-compliant mobile app lets clinicians review transmissions, sign reports, and coordinate care from anywhere. The University of Chicago Medicine reviewed more than 73,000 reports annually through Rhythm360 in 2025, averaging more than 18,000 reports per quarter, which demonstrates the platform's capacity to scale with high-volume device populations.

Talk to our team about integrating your specific OEM mix and EHR setup.

Rhythm360 Capabilities at a Glance

The table below summarizes how Rhythm360 addresses each interoperability gap discussed above, from data ingestion to revenue capture.

Capability Area	Rhythm360 Metric
Data Sources	API, HL7, XML, and PDF via computer vision, covering all major CIED OEMs (Medtronic, Boston Scientific, Abbott, Biotronik, and others)
Data Transmissibility	Greater than 99.9% data reliability via redundant feeds, AI extrapolation, and computer vision
Alert Handling	80% reduction in alert fatigue; AI triage prioritizes clinically significant events; optional 24/7/365 CCT oversight
Mobile Access	Secure, HIPAA-compliant mobile app for transmission review, report signing, and care coordination from any location
Revenue Capture	Automated CPT documentation (93298, 93299, 99454, and others)
EHR Integration	Bi-directional integration with Epic, Cerner, Athenahealth, eClinicalWorks, Greenway Health, and others via HL7
Annual Report Volume (UCM)	73,000+ reports reviewed annually, averaging 18,000+ per quarter at a single academic medical center

What to Expect When You Onboard Rhythm360

Onboarding and EHR integration with Rhythm360 typically take days to a few weeks, depending on the complexity of the existing EHR environment and the number of OEM data feeds being connected. The SaaS-based pricing model scales with clinic size and platform usage, which removes the high upfront costs that 47% of health system CIOs cite as a top barrier to interoperability investment. RhythmScience's implementation team manages the integration configuration, reducing the burden on internal IT staff and letting clinical teams start reviewing unified CIED data quickly.

Frequently Asked Questions

Do most cardiology practices already meet Level 3 or 4 interoperability?

No. Most still operate between Levels 1 and 2 for CIED data, receiving PDF or proprietary-format transmissions that require manual review. Regulatory pressure under TEFCA and the ONC HTI-1 Final Rule is pushing the industry toward Levels 3 and 4.

Will switching to a unified platform actually change our billing outcomes?

Yes. Manual reconciliation of transmission dates and clinician sign-offs is the main reason billing cycles get missed and claims get rejected. A platform that logs each billable event automatically and links it to the patient record removes that manual dependency and closes the gap between service delivery and claim submission.

How does TEFCA's growth affect a clinic that hasn't joined a QHIN yet?

As noted earlier, TEFCA exchange volume reached 600 million records by March 2026 across 11 designated QHINs, a scale that makes FHIR R4 and USCDI v3 compliance essential for any clinic coordinating care through these networks. Clinics whose monitoring platforms can't participate in FHIR-based exchange risk information blocking exposure and difficulty coordinating with referring hospitals.

Does Rhythm360 require replacing our existing EHR?

No. Rhythm360 integrates with the EHR rather than replacing it, using bi-directional HL7 connections with Epic, Cerner, Athenahealth, eClinicalWorks, and Greenway Health. CIED data flows into the existing clinical record instead of creating a parallel system.

Closing the Gap Between Compliance and Clinical Care

Healthcare interoperability is no longer an abstract IT objective. It is the operational and regulatory foundation cardiology practices must build their CIED monitoring programs on. Proprietary OEM formats, semantic inconsistencies across manufacturers, and the absence of vendor-agnostic infrastructure create daily clinical risk, administrative overload, and measurable revenue leakage.

The four levels of interoperability provide a framework for identifying where gaps exist. TEFCA, FHIR R4, and USCDI v3 set the compliance floor for 2026 and beyond. Rhythm360 addresses each level directly, normalizing multi-vendor data through API, HL7, XML, and AI-powered PDF parsing, prioritizing critical alerts, automating CPT documentation, and integrating bi-directionally with the EHR systems practices already use.

Ready to close your interoperability gaps? Connect with RhythmScience to get started.