Interoperability Matrix

There are currently more than 30 different electronic health record (EHR) systems participating in Direct message exchange with HSX.

Additionally, these EHR systems are supported by a variety of health information service providers (HISP). Recognizing the interoperability challenges that exist as a result of the number of vendors in the EHR market, HSX developed a comprehensive interoperability testing process. 

Since early 2015, this process has helped to address some of the interoperability challenges related to the receipt and rendering of patient information within EHRs. HSX uses the testing as it is onboarding new members and participants with Direct messaging and related services within the HIE.

The diagram below illustrates the results of the interoperability testing HSX has performed with its Participants. 

  • EHR systems are represented on the perimeter of the diagram, while the chords demonstrate the testing interactions/scenarios between each system.
  • On the right-hand side of the page, the provider entities represented in each respective testing scenario are displayed.
  • The size of the chord is determined by the prevalence of that particular system participating in Direct within HSX and that were tested as part of this process.

As more interoperability testing is completed, this diagram will be updated. Last updated: September, 2016.


Direct Operationalized / CCDA Messages Sent & Successfully Received (manual attachment to pt. chart)
Direct Issues Exist / Testing in Progress