What is a Standards & Interoperability (S&I) Initiative?

An individual Standards and Interoperability (S&I) Initiative is a project aimed at solving a particular challenge that hinders interoperability in the healthcare industry. The Initiative organizes work necessary for the development or evolution of deliverables that further enable interoperability. The Initiative has no formal status outside of that purpose. There are two types of Initiatives within the S&I Framework – Staff Assigned Initiatives and Community Assigned Initiatives.

Staff Assigned Initiatives

Initiatives that have formal staff allocations by the S&I Steering Team. The purpose of a Staff Assigned Initiative is to provide additional input and guidance to an area that the Office of the National Coordinator (or initiative sponsor, if applicable) has determined to be an interoperability priority.

Community Assigned Initiatives

Initiatives that do not have formal staff allocations by the S&I Steering Team, but are provided infrastructure support by the S&I Framework, such as use of the S&I Framework Wiki.


Transitions of Care

The purpose of this Initiative is to improve the exchange of core clinical information among providers, patients and other authorized entities electronically in support of meaningful use and IOM-identified needs for improvement in the quality of care. Learn More


Laboratory Results Interface

The purpose of this Initiative is to address the challenge of lab reporting to ambulatory primary care providers. This will be driven primarily by the needs of internal medicine, family practice and pediatrics, but may also be leveraged by other providers and settings. Learn More


Provider Directories

This initiative has two purposes:

  1. To determine the standards and specifications that should be used to enable discovery of a digital certificate when a recipient’s Direct Address is known (read more about the Direct Project)
  2. To determine the requirements, core data set and data model that are needed to query Provider Directories for electronic service information (such as SOAP address, Direct address, etc.) when some basic provider attributes are known. Learn More

Query Health

The purpose of this Initiative is to define the standards and services for distributed population health queries from certified EHRs and other sources of patient records. Learn More


Data Segmentation

The purpose of this Initiative is to enable the implementation and management of varying disclosure policies in an electronic health information exchange environment in an interoperable manner.  The goal is to enable a pilot project that allows providers to share portions of an electronic medical record while not sharing others, in line with applicable policy. Learn More



The esMD Initiative will offer providers a new mechanism for submitting medical documentation to review contractors, such as the CMS Improper Payments auditors. Learn More


Certificate Interoperability

This initiative aims to enable providers to electronically exchange and protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities. The preliminary focus was on developing an analysis of the issues related to complying with digital certificate requirements for exchanging data with Federal agencies. Learn More


Longitudinal Coordination of Care

The purpose of this initiative is to to support and advance patient-centric interoperable health information exchange across the long-term and post-acute care spectrum. Learn More


Public Health Reporting

The purpose of this initiative is to harmonize HIT standards and implementation guides for bi-directional interoperable communication between clinical care and public health entities for selected use cases. Learn More