The Challenges and Barriers in Standardized and Secure Data Exchange

While having different choices and options is an important part of life, some levels of standardization are easier, if not necessary. For example, we all have a favorite gas station based on where we live and what our price and snack preferences are, this is an area where having different choices is great. However, no matter what gas station you visit, all gas pumps have the same standard gas options with standardized octane levels, this standardization makes our lives so much easier and is crucial to having our cars work. In healthcare, being able to pick and choose which vendors, third parties, and technologies to use in our organization is very important. This freedom of choice allows us to customize our organizations to better serve our patients and staff. However, all of these different systems make it difficult to securely and reliably exchange data. Creating a standard for data exchange would make our lives significantly easier, but creating that standard isn’t going to be easy. Exchanging data isn’t something that we can merely measure out and agree on set parameters as we can for octane levels in gas. There are a lot of factors in play that make this much more complicated, but what exactly are those factors?

We asked our talented Healthcare IT Today Community – in the context of interoperability, what challenges and barriers exist in achieving standardized and secure data exchange across different healthcare systems, and how can these obstacles be addressed? The following are their answers.

Lance Reid, CEO at Telcion
There is a lot of activity in healthcare related to data sharing. Everyone knows they need to do it. It’s just a matter of the best way to get it done. Right now, many organizations have agreements between them for data sharing within the region they serve. Faxing, always to my surprise, continues to be the primary way that data is shared, especially with smaller entities. In the State of California, there is a mandate for improved data sharing for smaller entities by Jan 2026, and they are even providing incentives to get it done. However, one CEO I know refuses to do it because it requires data to be shared with the State and they don’t trust the State with this data. There aren’t any assurances being provided. With this thinking, it is likely that each entity will continue to make its own arrangements, which makes for a more complicated web of data-sharing transactions. That said, we are already seeing a Walmart-style model being deployed. The large insurance companies, hospitals, and healthcare systems have signed on to health information exchange and will mandate that any business conducted with them will require vendors to use the data exchanges they support. Over time, that will force each entity to get on board or miss out on future opportunities.

Srikumar Ramanathan, Chief Solutions Officer at Mphasis
The last few years have been a paradigm shift from where we stood a decade ago. Although HHS-OIG enforces penalties on actors involved in ‘information blocking’ for frictionless information flow, there are still concerns about competition among healthcare entities which has been the biggest roadblock in achieving full interoperability. More clarity will be needed on ‘information blocking exceptions’ so that they are not misused as a barrier to interoperability. With the newly proposed TEFCA HTI-2 rule, we are hoping concerns of many healthcare entities of competition, innovation, and consolidation are addressed. In fact, enhanced requirements on Information blocking promotes innovation in the industry and reduces competition/consolidation.

FHIR-based API usage by Payers (Government and Commercial) in the next few years will usher in enriched datasets to TEFCA networks. There is a need for partnership between public-private players to develop patient engagement applications (SMART on FHIR) for better access to data. Making patients a catalyst can accelerate this movement multi-fold. TEFCA is not just a mandate for creating a data feed for query/response of EHI (Electronic Health Information), rather it should be leveraged in a meaningful way for better insights in helping patients and bringing efficiencies using next-generation technologies of AI/ML (Artificial Intelligence/Machine Learning). All this is possible only if, healthcare entities are modernizing their systems for meaningful and secure sharing of data.

Kim Perry, Chief Growth Officer at emtelligent
Healthcare has made significant strides in interoperability over the past 15 years, and the CMS final rule regarding interoperability promises to further enhance health information exchange. However, this rule is only the first step. To truly empower patients to take control of their health data and ensure they remain at the center of care, healthcare data must also be useful. The promise of digital health data exchange will remain unfulfilled if we stop at merely enabling data flow. Most healthcare data is unstructured and locked in incompatible formats, such as indecipherable patient chart summaries or fragmented risk assessments, and healthcare organizations struggle to extract clinical or financial value from it. To fully realize the potential of interoperability, we must concurrently modernize the industry’s data processing pipelines and leverage AI, natural language processing, and large language models to advance the usability of healthcare data. By breaking down this final barrier in the clinical data pipeline, the healthcare industry can unlock the true value of its investment in digital health technology, ultimately transforming patient care and outcomes.

Zack Tisch, Senior Vice President, Healthcare Services at Pivot Point Consulting
Data interoperability has tremendous power in the U.S. health system to improve patient care, drive efficiencies, reduce costs, and empower patients. But the primary challenge that continues to hamper the deployment of interoperable solutions broadly across healthcare enterprises is the inconsistent adoption of, and governance around, announced standards.

A common challenge we see in advising a variety of our healthcare clients is that their clinical systems, which may be working with the same Protected Health Information (PHI) as another system and need to exchange data, may interpret and implement prior standards in differing ways, particularly around HL7 integration. While all the systems are speaking the same “language,” per the standard, there are different “dialects” and “slang,” if you will. Mapping those differences across hundreds of clinical and non-clinical applications and thousands of health systems is a daunting task.

Plus, we need to leverage technologies – such as AI and Generative AI — to augment, not replace, the human workflow and workforce of healthcare to make it more efficient, address burnout, improve care, and enhance patient health and outcomes. Data-sharing and interoperability are key. Leaving this to healthcare systems is not the answer. Many organizations adopt a ‘do no harm’ approach combined with HIPAA regulations to ensure that their patient records are safe. The challenge is that there is significant cost and effort to implement, manage, and maintain interoperable systems and processes with no real financial benefit (other than risk avoidance) back to the health system to help cover these costs.

TEFCA’s primary goal is to continue the progress made by former interoperability frameworks through improved governance, standards, and accelerated use of easier-to-adopt integration technologies such as FHIR. TEFCA also seeks to provide a comprehensive approach inclusive of cybersecurity, identity & access management, regulatory compliance, and data analytics.

The industry needs the robust implementation of and governance around universal data-sharing standards to effectively share data among providers and harness the latest tech for overall good.

Marlena Herrera, Director, Customer Success at Protegrity
While frameworks and standards significantly help interoperability, the challenges often lie in the details of how the exchange occurs. Establishing best practices, interface controls, and technical data standards for how the data is stored, exchanged, protected, and experienced by its users across the Qualified Health Information Networks [QHINs] will create additional controls and a consistent experience for all entities involved in adoption.

Don Rucker, Chief Strategy Officer at 1upHealth
The most important barrier to interoperability is not technical – it is financial. In the US healthcare system, almost all the profit margin is generated by high-cost medical and surgical procedures. Consolidated delivery systems and their software providers have little incentive to actually interoperate because that implies patients could shop, move their medical records, and take their high-margin business elsewhere (known in the trade as “leakage”). So today healthcare interoperability still relies on brittle organizational approaches and needs federal regulations requiring modern APIs.

Laxmi Patel, Chief Strategy Officer at Savista
Achieving standardized and secure data exchange across different healthcare systems presents several challenges and barriers. These barriers can stem from a lack of data standardization as different healthcare providers may use various standards (HL7, FHIR, ICD-10, SNOMED CT), use outdated technology, and inconsistent data entry practices leading to poor data quality which makes exchange and interoperability challenging to cost to implement. Implementing interoperable systems can be expensive, involving both initial investments and ongoing maintenance. To address these obstacles, organizations can promote the widespread adoption of established standards like HL7 FHIR to ensure consistency in data formats and communication protocol, implement middleware and interoperability platforms that can bridge different systems and translate data format or utilize cloud-based solutions that offer scalable and flexible integration capabilities, standardize data entry processes and provide training to healthcare professionals to minimize errors, and develop comprehensive policies that support interoperability and ensure alignment across various regulatory frameworks.

Colby Takeda, Co-Founder and CEO at Pear Suite
As healthcare companies utilize new solutions to increase data sharing and improve care coordination, they must also consider interoperability with non-traditional providers, such as community health workers (CHWs), doulas, promotores, and others working in community-based nonprofits. Unlike other provider types, these frontline, community-based providers have historically assessed and addressed client needs with paper surveys, notepads, and spreadsheets. Despite their low-tech approach, these community-based providers are extremely effective in building trust, understanding needs, and utilizing local resources to solve health and social challenges. More and more healthcare organizations are recognizing the high value of these community-based providers, especially when engaging underserved communities with the social determinants of health, and are exploring ways to contract with them. Armed with the right tools, information, and support, these providers could become key members of the care team, increasing operational efficiency and quality, while minimizing risk.

Darrell Johnson, Chief Strategy Officer at RLDatix
The healthcare industry has more data than any other industry, and it doubles almost every three years. Our health systems must advance solutions to not pass this complexity onto patients in the form of poor quality or higher costs. Removing data blocking and silos is key to addressing this challenge head-on. Technologies are advancing rapidly to enhance interoperability, data sharing, and privacy across the healthcare ecosystem, so now is the time to embrace these changes across healthcare operations to standardize data for reporting and insights that will provide care teams and leaders with actionable insights to improve safety. The result will be improved decision-making that reduces risk, prevents harm, and improves the quality and outcomes of care being delivered.

Kel Pults, Chief Clinical Officer and VP Government Strategy at MediQuant
Healthcare interoperability has advanced significantly over the past decade. Most organizations now have some form of EHR, and even those with paper records have largely digitized them. This shift has greatly improved data sharing between organizations and major EHR vendors. These vendors are now focusing on standardizing data sharing to improve patient experiences. TEFCA is playing a crucial role here, especially with initiatives like Qualified Health Information Networks (QHINs). However, even with these advancements, there are still hurdles. For example, data sharing across organizations using the same EHR system remains inconsistent due to varying data standards and user proficiency levels. TEFCA, along with the ONC, is addressing these challenges by developing standards like FHIR for information exchange. However, setting up FHIR varies between systems, leading to inconsistencies that need resolution. Hopefully, in the next five years, there will be a clearer understanding of what “standard” truly means in this context.

One of the biggest challenges in healthcare interoperability is the lack of a unique patient identifier. This leads to cumbersome processes and delays in patient care. Patients often find themselves caught in the middle of finger-pointing between organizations over who should handle the data requests. There’s a clear need for greater patient involvement in managing their data. Imagine if patients could authorize data sharing with a single, comprehensive permission, much like managing cookie preferences online. This could significantly streamline data sharing and reduce the confusion that currently exists. Innovative technologies like AI, machine learning, and natural language processing (NLP) are at the forefront of enhancing interoperability. By standardizing and tagging data, NLP enables easier data searching and retrieval, crucial for healthcare providers who need quick access to specific information. Unlike cumbersome PDFs, which require tedious scrolling, discrete data sets allow providers to swiftly access the necessary details, improving efficiency and care quality. However, legacy systems that stored entire patient records in single PDFs pose challenges, as extracting specific data points from these documents is difficult. AI, ML, and NLP are now being employed to break down these large documents into usable discrete elements, ultimately aiming to reduce the risk and liability associated with data mismanagement. These advancements highlight the importance of a more structured approach to data handling in healthcare.

Moving forward, it’s imperative that regulatory bodies like the ONC enforce stricter standards to ensure that data stored discreetly is accessible and usable. This will be key to maximizing the benefits of these technological advancements in healthcare.

Jessica Wagner, Chief Operating Officer at RXNT
Despite the advancements, significant challenges persist in achieving standardized and secure data exchange. The primary barriers include disconnected data sources, varying levels of technology adoption among providers, differing capabilities among Health Information Exchanges (HIEs), and the need for health IT platforms to integrate effectively. To overcome these obstacles, it is essential to work toward widespread adoption of TEFCA and compliance with FHIR and HL7 standards across all healthcare entities. Additionally, ongoing updates and support are crucial to help these networks fully mature and operate efficiently.

Diana Sonbay-Benli, VP & Chief Product Officer, Cognizant TriZetto Healthcare Products at Cognizant
It’s crucial to consider “the network effect.” The network effect occurs when the value of a network increases as more stakeholders use it. In healthcare interoperability, this means that as more healthcare entities adopt and use standardized data exchange protocols, the overall system becomes more valuable and efficient for all participants. Multiple, complex blockers have inhibited the potential of healthcare interoperability. These include the lack of technical standards, privacy and security concerns, absence of government mandates, and business models and company cultures that have not evolved to prioritize collaboration and trust. Many of these blockers are being addressed today through groups such as the Da Vinci Project, new federal and state regulations, and new payvider-oriented business models. What’s key to note is the need for and nature of critical mass. At some point, a key tipping point will be reached, and it will be “table stakes” to have business and operating models that assume and leverage interoperability to drive differentiated member and patient experiences. We’ve seen it in other industries, from financial services to telecommunications to travel, where businesses have had to redefine themselves when the tipping point of change is reached.

Hans Buitendijk, Public Health Workgroup Chair & Executive Committee Member at EHR Association
Interoperability requires alignment by the community on a variety of topics:

• Common Agreement – Establishing an acceptable set of terms that everybody can sign up to no or very limited point-to-point agreements. TEFCA took the next step based on the experiences of all HIEs — local, regional, or national. As we cast the net wider, keeping the common agreement current and inclusive will be critical to ensuring wide participation.
• Standards – For each exchange purpose and use case, alignment on common access and exchange standards covering authorization/authentication/trust, identity, record matching, syntax/format, semantics/vocabulary, transport, and method (push, pull, notification, document, data set, etc.) is critical to enable consistent, scalable connections. Not all relevant standards to enable this at scale are mature enough. For example, establishing system-level trust (authorization/authentication/registration of apps and systems) in a network-level FHIR-enabled environment is a work in progress and a key technical focus for TEFCA. Development and alignment of the necessary standards will be an ongoing evolution that requires continuous collaboration within the networks and with the standards development organizations to fill gaps and address new use cases.
• Governance – A common thread across these topics is the necessary governance that guides advancements and differences in interpretations, including all perspectives and stakeholders while remaining efficient and nimble to engender trust.

Ankur Mathakia, Solutions Architect, Interoperability, Digital Health at Nordic Global Consulting
It’s important to remember how the healthcare market started. The fragmentation that exists has been there from the beginning since we did not have unified standards to develop towards. Contrast this with other industries and mediums, like the internet, where standards of development and interoperability have provided a framework for established corporations and startups to compete and collaborate. This is why siloed data and systems that do not exchange data easily persist in healthcare. Healthcare is an ecosystem where established leaders, new entrants, and regulatory bodies must work together to create and maintain enforceable standards of interoperability. Now, the healthcare industry must set the standards after the fact.

To improve our current state, TEFCA and government agencies in Europe and Canada are pushing for cohesive interoperability standards to align with specific technologies in healthcare. FHIR APIs are the new interoperability trend – and for good reason – as they are an easier and less resistant path to integration. FHIR APIs also generally use a JSON formatted document for data exchange and oAuth2 and mTLS for security layering, which are standards used in other industries. The use of standards enables people outside of healthcare to enter the industry and push innovation forward using a new mindset. Many talented engineers know these technologies but lack specific healthcare industry knowledge. There is now no longer that strong barrier to innovation.

I’m optimistic about where healthcare interoperability is headed because I’ve seen over the last two decades how the industry has evolved. I’m most encouraged about the future since the new standards enable innovative companies, startups, and industry leaders that aren’t necessarily involved in healthcare to share the know-how of data exchange in the healthcare environment and drive innovation. We’re now seeing a lot of health tech organizations and third-party companies advance patient care and outcomes. Their avenue into the ecosystem has been created because of the standards of data transmissions and interoperability. Standardized and secure data exchange is now getting a lot of attention, and huge investment dollars are going into the space. We often think about government standards and regulations as stifling private industry, but TEFCA and the regulatory acts that have preceded it to set standards around interoperability in healthcare have actually spurred innovation by providing defined pathways to integration.

Adam Hesse, CEO at Full Spectrum
Existing system implementations – many health information systems were installed, configured, and connected years, maybe even decades ago. These systems are extremely time-consuming to implement and may involve connections to hundreds of other systems or devices. If an individual facility were to decide to adopt all standard interfaces, each legacy system connection would need to be re-tested, ensuring that all customizations are accounted for. This transition must occur without negatively impacting the user base and ensuring operational continuity.

Zach Evans, Chief Technology Officer at Xsolis
The challenges of achieving standardized data exchange begin with the fact that different healthcare providers use diverse systems that are not designed to communicate with each other. Additionally, there is a lack of universally accepted data standards for data formats. HL7v2 allows for so much flexibility and variability that—even when two systems attempt to communicate with one another—there is still a tremendous amount of data normalization and mapping that must happen on both ends. HL7 FHIR attempts to solve many of these challenges, but adoption has been slowed by the fact that many healthcare providers are struggling to address a tremendous amount of sunk costs in legacy systems that aren’t compatible with the latest data standards.

Enrique Estrada, Solutions Executive, Healthcare at Nordic Global
A little over a decade ago, the only primary data health systems were interoperating with was payer and provider. This was our traditional HL7v2, C-CDAs, 834, 837, etc. Fast forward to today, everyone has a mobile phone with an app to track moods, mental health, and activity. We are seeing new at-home care data for activities focused on daily living, remote patient monitoring, and digital therapeutics. Additionally, the industry is incorporating non-traditional data sets, such as social determinants of health (SDOH), consumer patterns, zip codes, and more. The landscape has changed in a short time span. We know these new data models will yield new insights, predictability, and behavior health patterns that were unknown before, but if we don’t focus on a trusted framework to communicate, then the new generation of data will set us further back. We can’t afford to repeat those same mistakes and revisit the same challenges 10 years from now when we have another new set of data sets to incorporate.

So many things to think about here! Huge thank you to Lance Reid, CEO at Telcion, Srikumar Ramanathan, Chief Solutions Officer at Mphasis, Kim Perry, Chief Growth Officer at emtelligent, Zack Tisch, Senior Vice President, Healthcare Services at Pivot Point Consulting, Marlena Herrera, Director, Customer Success at Protegrity, Don Rucker, Chief Strategy Officer at 1upHealth, Laxmi Patel, Chief Strategy Officer at Savista, Colby Takeda, Co-Founder and CEO at Pear Suite, Darrell Johnson, Chief Strategy Officer at RLDatix, Kel Pults, Chief Clinical Officer and VP Government Strategy at MediQuant, Jessica Wagner, Chief Operating Officer at RXNT, Diana Sonbay-Benli, VP & Chief Product Officer, Cognizant TriZetto Healthcare Products at Cognizant, Hans Buitendijk, Public Health Workgroup Chair & Executive Committee Member at EHR Association, Ankur Mathakia, Solutions Architect, Interoperability, Digital Health at Nordic Global Consulting, Adam Hesse, CEO at Full Spectrum, Zach Evans, Chief Technology Officer at Xsolis, and Enrique Estrada, Solutions Executive, Healthcare at Nordic Global for taking the time out of your day to submit a quote in to us! And thank you to all of you for taking the time out of your day to read this article! We could not do this without all of your support.

In the context of interoperability, what challenges and barriers do you think exist in achieving standardized and secure data exchange across different healthcare systems, and how can these obstacles be addressed? Let us know either in the comments down below or over on social media. We’d love to hear from all of you!

While having different choices and options is an important part of life, some levels of standardization are easier, if not necessary. For example, we all have a favorite gas station based on where we live and what our price and snack preferences are, this is an area where having different choices is great. However, no matter what gas station you visit, all gas pumps have the same standard gas options with standardized octane levels, this standardization makes our lives so much easier and is crucial to having our cars work. In healthcare, being able to pick and choose which vendors, third parties, and technologies to use in our organization is very important. This freedom of choice allows us to customize our organizations to better serve our patients and staff. However, all of these different systems make it difficult to securely and reliably exchange data. Creating a standard for data exchange would make our lives significantly easier, but creating that standard isn’t going to be easy. Exchanging data isn’t something that we can merely measure out and agree on set parameters as we can for octane levels in gas. There are a lot of factors in play that make this much more complicated, but what exactly are those factors?

We asked our talented Healthcare IT Today Community – in the context of interoperability, what challenges and barriers exist in achieving standardized and secure data exchange across different healthcare systems, and how can these obstacles be addressed? The following are their answers.

Lance Reid, CEO at Telcion
There is a lot of activity in healthcare related to data sharing. Everyone knows they need to do it. It’s just a matter of the best way to get it done. Right now, many organizations have agreements between them for data sharing within the region they serve. Faxing, always to my surprise, continues to be the primary way that data is shared, especially with smaller entities. In the State of California, there is a mandate for improved data sharing for smaller entities by Jan 2026, and they are even providing incentives to get it done. However, one CEO I know refuses to do it because it requires data to be shared with the State and they don’t trust the State with this data. There aren’t any assurances being provided. With this thinking, it is likely that each entity will continue to make its own arrangements, which makes for a more complicated web of data-sharing transactions. That said, we are already seeing a Walmart-style model being deployed. The large insurance companies, hospitals, and healthcare systems have signed on to health information exchange and will mandate that any business conducted with them will require vendors to use the data exchanges they support. Over time, that will force each entity to get on board or miss out on future opportunities.

Srikumar Ramanathan, Chief Solutions Officer at Mphasis
The last few years have been a paradigm shift from where we stood a decade ago. Although HHS-OIG enforces penalties on actors involved in ‘information blocking’ for frictionless information flow, there are still concerns about competition among healthcare entities which has been the biggest roadblock in achieving full interoperability. More clarity will be needed on ‘information blocking exceptions’ so that they are not misused as a barrier to interoperability. With the newly proposed TEFCA HTI-2 rule, we are hoping concerns of many healthcare entities of competition, innovation, and consolidation are addressed. In fact, enhanced requirements on Information blocking promotes innovation in the industry and reduces competition/consolidation.

FHIR-based API usage by Payers (Government and Commercial) in the next few years will usher in enriched datasets to TEFCA networks. There is a need for partnership between public-private players to develop patient engagement applications (SMART on FHIR) for better access to data. Making patients a catalyst can accelerate this movement multi-fold. TEFCA is not just a mandate for creating a data feed for query/response of EHI (Electronic Health Information), rather it should be leveraged in a meaningful way for better insights in helping patients and bringing efficiencies using next-generation technologies of AI/ML (Artificial Intelligence/Machine Learning). All this is possible only if, healthcare entities are modernizing their systems for meaningful and secure sharing of data.

Kim Perry, Chief Growth Officer at emtelligent
Healthcare has made significant strides in interoperability over the past 15 years, and the CMS final rule regarding interoperability promises to further enhance health information exchange. However, this rule is only the first step. To truly empower patients to take control of their health data and ensure they remain at the center of care, healthcare data must also be useful. The promise of digital health data exchange will remain unfulfilled if we stop at merely enabling data flow. Most healthcare data is unstructured and locked in incompatible formats, such as indecipherable patient chart summaries or fragmented risk assessments, and healthcare organizations struggle to extract clinical or financial value from it. To fully realize the potential of interoperability, we must concurrently modernize the industry’s data processing pipelines and leverage AI, natural language processing, and large language models to advance the usability of healthcare data. By breaking down this final barrier in the clinical data pipeline, the healthcare industry can unlock the true value of its investment in digital health technology, ultimately transforming patient care and outcomes.

Zack Tisch, Senior Vice President, Healthcare Services at Pivot Point Consulting
Data interoperability has tremendous power in the U.S. health system to improve patient care, drive efficiencies, reduce costs, and empower patients. But the primary challenge that continues to hamper the deployment of interoperable solutions broadly across healthcare enterprises is the inconsistent adoption of, and governance around, announced standards.

A common challenge we see in advising a variety of our healthcare clients is that their clinical systems, which may be working with the same Protected Health Information (PHI) as another system and need to exchange data, may interpret and implement prior standards in differing ways, particularly around HL7 integration. While all the systems are speaking the same “language,” per the standard, there are different “dialects” and “slang,” if you will. Mapping those differences across hundreds of clinical and non-clinical applications and thousands of health systems is a daunting task.

Plus, we need to leverage technologies – such as AI and Generative AI — to augment, not replace, the human workflow and workforce of healthcare to make it more efficient, address burnout, improve care, and enhance patient health and outcomes. Data-sharing and interoperability are key. Leaving this to healthcare systems is not the answer. Many organizations adopt a ‘do no harm’ approach combined with HIPAA regulations to ensure that their patient records are safe. The challenge is that there is significant cost and effort to implement, manage, and maintain interoperable systems and processes with no real financial benefit (other than risk avoidance) back to the health system to help cover these costs.

TEFCA’s primary goal is to continue the progress made by former interoperability frameworks through improved governance, standards, and accelerated use of easier-to-adopt integration technologies such as FHIR. TEFCA also seeks to provide a comprehensive approach inclusive of cybersecurity, identity & access management, regulatory compliance, and data analytics.

The industry needs the robust implementation of and governance around universal data-sharing standards to effectively share data among providers and harness the latest tech for overall good.

Marlena Herrera, Director, Customer Success at Protegrity
While frameworks and standards significantly help interoperability, the challenges often lie in the details of how the exchange occurs. Establishing best practices, interface controls, and technical data standards for how the data is stored, exchanged, protected, and experienced by its users across the Qualified Health Information Networks [QHINs] will create additional controls and a consistent experience for all entities involved in adoption.

Don Rucker, Chief Strategy Officer at 1upHealth
The most important barrier to interoperability is not technical – it is financial. In the US healthcare system, almost all the profit margin is generated by high-cost medical and surgical procedures. Consolidated delivery systems and their software providers have little incentive to actually interoperate because that implies patients could shop, move their medical records, and take their high-margin business elsewhere (known in the trade as “leakage”). So today healthcare interoperability still relies on brittle organizational approaches and needs federal regulations requiring modern APIs.

Laxmi Patel, Chief Strategy Officer at Savista
Achieving standardized and secure data exchange across different healthcare systems presents several challenges and barriers. These barriers can stem from a lack of data standardization as different healthcare providers may use various standards (HL7, FHIR, ICD-10, SNOMED CT), use outdated technology, and inconsistent data entry practices leading to poor data quality which makes exchange and interoperability challenging to cost to implement. Implementing interoperable systems can be expensive, involving both initial investments and ongoing maintenance. To address these obstacles, organizations can promote the widespread adoption of established standards like HL7 FHIR to ensure consistency in data formats and communication protocol, implement middleware and interoperability platforms that can bridge different systems and translate data format or utilize cloud-based solutions that offer scalable and flexible integration capabilities, standardize data entry processes and provide training to healthcare professionals to minimize errors, and develop comprehensive policies that support interoperability and ensure alignment across various regulatory frameworks.

Colby Takeda, Co-Founder and CEO at Pear Suite
As healthcare companies utilize new solutions to increase data sharing and improve care coordination, they must also consider interoperability with non-traditional providers, such as community health workers (CHWs), doulas, promotores, and others working in community-based nonprofits. Unlike other provider types, these frontline, community-based providers have historically assessed and addressed client needs with paper surveys, notepads, and spreadsheets. Despite their low-tech approach, these community-based providers are extremely effective in building trust, understanding needs, and utilizing local resources to solve health and social challenges. More and more healthcare organizations are recognizing the high value of these community-based providers, especially when engaging underserved communities with the social determinants of health, and are exploring ways to contract with them. Armed with the right tools, information, and support, these providers could become key members of the care team, increasing operational efficiency and quality, while minimizing risk.

Darrell Johnson, Chief Strategy Officer at RLDatix
The healthcare industry has more data than any other industry, and it doubles almost every three years. Our health systems must advance solutions to not pass this complexity onto patients in the form of poor quality or higher costs. Removing data blocking and silos is key to addressing this challenge head-on. Technologies are advancing rapidly to enhance interoperability, data sharing, and privacy across the healthcare ecosystem, so now is the time to embrace these changes across healthcare operations to standardize data for reporting and insights that will provide care teams and leaders with actionable insights to improve safety. The result will be improved decision-making that reduces risk, prevents harm, and improves the quality and outcomes of care being delivered.

Kel Pults, Chief Clinical Officer and VP Government Strategy at MediQuant
Healthcare interoperability has advanced significantly over the past decade. Most organizations now have some form of EHR, and even those with paper records have largely digitized them. This shift has greatly improved data sharing between organizations and major EHR vendors. These vendors are now focusing on standardizing data sharing to improve patient experiences. TEFCA is playing a crucial role here, especially with initiatives like Qualified Health Information Networks (QHINs). However, even with these advancements, there are still hurdles. For example, data sharing across organizations using the same EHR system remains inconsistent due to varying data standards and user proficiency levels. TEFCA, along with the ONC, is addressing these challenges by developing standards like FHIR for information exchange. However, setting up FHIR varies between systems, leading to inconsistencies that need resolution. Hopefully, in the next five years, there will be a clearer understanding of what “standard” truly means in this context.

One of the biggest challenges in healthcare interoperability is the lack of a unique patient identifier. This leads to cumbersome processes and delays in patient care. Patients often find themselves caught in the middle of finger-pointing between organizations over who should handle the data requests. There’s a clear need for greater patient involvement in managing their data. Imagine if patients could authorize data sharing with a single, comprehensive permission, much like managing cookie preferences online. This could significantly streamline data sharing and reduce the confusion that currently exists. Innovative technologies like AI, machine learning, and natural language processing (NLP) are at the forefront of enhancing interoperability. By standardizing and tagging data, NLP enables easier data searching and retrieval, crucial for healthcare providers who need quick access to specific information. Unlike cumbersome PDFs, which require tedious scrolling, discrete data sets allow providers to swiftly access the necessary details, improving efficiency and care quality. However, legacy systems that stored entire patient records in single PDFs pose challenges, as extracting specific data points from these documents is difficult. AI, ML, and NLP are now being employed to break down these large documents into usable discrete elements, ultimately aiming to reduce the risk and liability associated with data mismanagement. These advancements highlight the importance of a more structured approach to data handling in healthcare.

Moving forward, it’s imperative that regulatory bodies like the ONC enforce stricter standards to ensure that data stored discreetly is accessible and usable. This will be key to maximizing the benefits of these technological advancements in healthcare.

Jessica Wagner, Chief Operating Officer at RXNT
Despite the advancements, significant challenges persist in achieving standardized and secure data exchange. The primary barriers include disconnected data sources, varying levels of technology adoption among providers, differing capabilities among Health Information Exchanges (HIEs), and the need for health IT platforms to integrate effectively. To overcome these obstacles, it is essential to work toward widespread adoption of TEFCA and compliance with FHIR and HL7 standards across all healthcare entities. Additionally, ongoing updates and support are crucial to help these networks fully mature and operate efficiently.

Diana Sonbay-Benli, VP & Chief Product Officer, Cognizant TriZetto Healthcare Products at Cognizant
It’s crucial to consider “the network effect.” The network effect occurs when the value of a network increases as more stakeholders use it. In healthcare interoperability, this means that as more healthcare entities adopt and use standardized data exchange protocols, the overall system becomes more valuable and efficient for all participants. Multiple, complex blockers have inhibited the potential of healthcare interoperability. These include the lack of technical standards, privacy and security concerns, absence of government mandates, and business models and company cultures that have not evolved to prioritize collaboration and trust. Many of these blockers are being addressed today through groups such as the Da Vinci Project, new federal and state regulations, and new payvider-oriented business models. What’s key to note is the need for and nature of critical mass. At some point, a key tipping point will be reached, and it will be “table stakes” to have business and operating models that assume and leverage interoperability to drive differentiated member and patient experiences. We’ve seen it in other industries, from financial services to telecommunications to travel, where businesses have had to redefine themselves when the tipping point of change is reached.

Hans Buitendijk, Public Health Workgroup Chair & Executive Committee Member at EHR Association
Interoperability requires alignment by the community on a variety of topics:

• Common Agreement – Establishing an acceptable set of terms that everybody can sign up to no or very limited point-to-point agreements. TEFCA took the next step based on the experiences of all HIEs — local, regional, or national. As we cast the net wider, keeping the common agreement current and inclusive will be critical to ensuring wide participation.
• Standards – For each exchange purpose and use case, alignment on common access and exchange standards covering authorization/authentication/trust, identity, record matching, syntax/format, semantics/vocabulary, transport, and method (push, pull, notification, document, data set, etc.) is critical to enable consistent, scalable connections. Not all relevant standards to enable this at scale are mature enough. For example, establishing system-level trust (authorization/authentication/registration of apps and systems) in a network-level FHIR-enabled environment is a work in progress and a key technical focus for TEFCA. Development and alignment of the necessary standards will be an ongoing evolution that requires continuous collaboration within the networks and with the standards development organizations to fill gaps and address new use cases.
• Governance – A common thread across these topics is the necessary governance that guides advancements and differences in interpretations, including all perspectives and stakeholders while remaining efficient and nimble to engender trust.

Ankur Mathakia, Solutions Architect, Interoperability, Digital Health at Nordic Global Consulting
It’s important to remember how the healthcare market started. The fragmentation that exists has been there from the beginning since we did not have unified standards to develop towards. Contrast this with other industries and mediums, like the internet, where standards of development and interoperability have provided a framework for established corporations and startups to compete and collaborate. This is why siloed data and systems that do not exchange data easily persist in healthcare. Healthcare is an ecosystem where established leaders, new entrants, and regulatory bodies must work together to create and maintain enforceable standards of interoperability. Now, the healthcare industry must set the standards after the fact.

To improve our current state, TEFCA and government agencies in Europe and Canada are pushing for cohesive interoperability standards to align with specific technologies in healthcare. FHIR APIs are the new interoperability trend – and for good reason – as they are an easier and less resistant path to integration. FHIR APIs also generally use a JSON formatted document for data exchange and oAuth2 and mTLS for security layering, which are standards used in other industries. The use of standards enables people outside of healthcare to enter the industry and push innovation forward using a new mindset. Many talented engineers know these technologies but lack specific healthcare industry knowledge. There is now no longer that strong barrier to innovation.

I’m optimistic about where healthcare interoperability is headed because I’ve seen over the last two decades how the industry has evolved. I’m most encouraged about the future since the new standards enable innovative companies, startups, and industry leaders that aren’t necessarily involved in healthcare to share the know-how of data exchange in the healthcare environment and drive innovation. We’re now seeing a lot of health tech organizations and third-party companies advance patient care and outcomes. Their avenue into the ecosystem has been created because of the standards of data transmissions and interoperability. Standardized and secure data exchange is now getting a lot of attention, and huge investment dollars are going into the space. We often think about government standards and regulations as stifling private industry, but TEFCA and the regulatory acts that have preceded it to set standards around interoperability in healthcare have actually spurred innovation by providing defined pathways to integration.

Adam Hesse, CEO at Full Spectrum
Existing system implementations – many health information systems were installed, configured, and connected years, maybe even decades ago. These systems are extremely time-consuming to implement and may involve connections to hundreds of other systems or devices. If an individual facility were to decide to adopt all standard interfaces, each legacy system connection would need to be re-tested, ensuring that all customizations are accounted for. This transition must occur without negatively impacting the user base and ensuring operational continuity.

Zach Evans, Chief Technology Officer at Xsolis
The challenges of achieving standardized data exchange begin with the fact that different healthcare providers use diverse systems that are not designed to communicate with each other. Additionally, there is a lack of universally accepted data standards for data formats. HL7v2 allows for so much flexibility and variability that—even when two systems attempt to communicate with one another—there is still a tremendous amount of data normalization and mapping that must happen on both ends. HL7 FHIR attempts to solve many of these challenges, but adoption has been slowed by the fact that many healthcare providers are struggling to address a tremendous amount of sunk costs in legacy systems that aren’t compatible with the latest data standards.

Enrique Estrada, Solutions Executive, Healthcare at Nordic Global
A little over a decade ago, the only primary data health systems were interoperating with was payer and provider. This was our traditional HL7v2, C-CDAs, 834, 837, etc. Fast forward to today, everyone has a mobile phone with an app to track moods, mental health, and activity. We are seeing new at-home care data for activities focused on daily living, remote patient monitoring, and digital therapeutics. Additionally, the industry is incorporating non-traditional data sets, such as social determinants of health (SDOH), consumer patterns, zip codes, and more. The landscape has changed in a short time span. We know these new data models will yield new insights, predictability, and behavior health patterns that were unknown before, but if we don’t focus on a trusted framework to communicate, then the new generation of data will set us further back. We can’t afford to repeat those same mistakes and revisit the same challenges 10 years from now when we have another new set of data sets to incorporate.

So many things to think about here! Huge thank you to Lance Reid, CEO at Telcion, Srikumar Ramanathan, Chief Solutions Officer at Mphasis, Kim Perry, Chief Growth Officer at emtelligent, Zack Tisch, Senior Vice President, Healthcare Services at Pivot Point Consulting, Marlena Herrera, Director, Customer Success at Protegrity, Don Rucker, Chief Strategy Officer at 1upHealth, Laxmi Patel, Chief Strategy Officer at Savista, Colby Takeda, Co-Founder and CEO at Pear Suite, Darrell Johnson, Chief Strategy Officer at RLDatix, Kel Pults, Chief Clinical Officer and VP Government Strategy at MediQuant, Jessica Wagner, Chief Operating Officer at RXNT, Diana Sonbay-Benli, VP & Chief Product Officer, Cognizant TriZetto Healthcare Products at Cognizant, Hans Buitendijk, Public Health Workgroup Chair & Executive Committee Member at EHR Association, Ankur Mathakia, Solutions Architect, Interoperability, Digital Health at Nordic Global Consulting, Adam Hesse, CEO at Full Spectrum, Zach Evans, Chief Technology Officer at Xsolis, and Enrique Estrada, Solutions Executive, Healthcare at Nordic Global for taking the time out of your day to submit a quote in to us! And thank you to all of you for taking the time out of your day to read this article! We could not do this without all of your support.

In the context of interoperability, what challenges and barriers do you think exist in achieving standardized and secure data exchange across different healthcare systems, and how can these obstacles be addressed? Let us know either in the comments down below or over on social media. We’d love to hear from all of you!