Barriers to improving the US healthcare system include a lack of interoperability across digital health information and delays in seeking preventative and recommended care. Interoperability can be seen as the lynch pin to reducing fragmentation and improving outcomes related to digital health systems. The prevailing standard for information exchange to enable interoperability is the Health Level Seven International Fast Healthcare Interoperable Resources standard. To better understand Fast Healthcare Interoperable Resources within the context of computerized clinical decision support expert interviews of health informaticists were conducted and used to create a modified force field analysis. Current barriers and future recommendations to scale adoption of Fast Healthcare Interoperable Resources were explored through qualitative analysis of expert interviews. Identified barriers included variation in electronic health record implementation, limited electronic health record vendor support, ontology variation, limited workforce knowledge, and testing limitations. Experts recommended research funders require Fast Healthcare Interoperable Resource usage, development of an "app store," incentives for clinical organizations and electronic health record vendors, and Fast Healthcare Interoperable Resource certification development.
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