This document is a report discussing the interoperability challenges faced by the health IT sector as outlined by the Office of the National Coordinator for Health IT (ONC). It emphasizes the need for collaboration and innovation to enhance the US health IT infrastructure, particularly in implementing the provisions of the 21st Century Cares Act. The report identifies six specific man-made barriers to interoperability, including technical and financial issues, as well as administrative requirements. It highlights successful initiatives, such as the shared Medicaid Management Information System (MMIS) between Illinois and Michigan, which has resulted in significant cost savings. Additionally, it mentions the development of a mobile app funded by the CDC to streamline the reporting of causes of death, showcasing how technology can improve public health outcomes. The document concludes by acknowledging the existence of both challenges and solutions in achieving interoperability in health IT.