We all know that true interoperability is something that will drastically improve the lives of our patients, the lives of our staff, and our organizations as a whole — I don’t think there’s anyone who doesn’t want to achieve true interoperability in their organization. However, knowing how amazing it is and wanting it for ourselves does not automatically mean we can have it. Tragically, there are various barriers throughout different sections of the healthcare system that are preventing us from achieving this goal.
To help us identify these barriers, as well as invent solutions to remove them, we reached out to our incredible Healthcare IT Today Community to ask: What are the main barriers to achieving true interoperability in healthcare IT, and how can organizations overcome them? The following is what they had to share.
Luigi Leblanc, Vice President of Technology at Zane Networks
Achieving true interoperability in healthcare data sharing remains challenging as national frameworks like the Trusted Exchange Framework and Common Agreement (TEFCA) continue to evolve. While TEFCA presents promising opportunities for compliant data exchange, current implementation requires hybrid approaches that leverage existing infrastructure while meeting market demand to expand network access through modern APIs such as FHIR. A common framework provides opportunities for various national partners—QHINs, HDUs, HIEs, and public health platforms such as AIMs—to access critical capabilities like decision support, scalability, and security.
However, the hybrid approach needs to empower “last mile” interoperability while organizations transition to data sharing within TEFCA. The downstream capabilities and technical requirements don’t just need to be enabled but will require providers and organizations to realize the value added by using modern APIs. Depending on the use case, such benefits can be amplified when leveraging a national network.
Katie Devlin, Vice President, Interoperability at Cotiviti, Inc.
Achieving true interoperability requires organizations to move beyond meeting CMS mandates and focus on aligning standards, data governance, workflows, and incentives across the healthcare ecosystem. Today, multiple standards—FHIR, HL7, and CDA—coexist, often with inconsistent implementations. To succeed, organizations should adopt a scalable, multi-faceted approach that supports legacy formats like CDA and HL7 while enabling FHIR R4/R5 to power emerging workflows such as digital quality reporting. Equally important is linking interoperability to measurable ROI, including enhanced risk stratification, and leveraging regulatory frameworks like TEFCA to accelerate compliance and adoption.
Dr. Lucienne Ide, Founder and Chief Executive Officer at Rimidi
True interoperability in healthcare IT remains frustratingly out of reach — not because the industry lacks technology, but because dedication to implementing it effectively and incentives to encourage its use are lacking. Fast Healthcare Interoperability Resources (FHIR) has been transformational, but its full potential hasn’t been realized. Many EHRs technically meet requirements to offer FHIR APIs, which let systems communicate and interact with each other, but in practice, these APIs are often poorly implemented or functionally limited.
Instead of moving forward, healthcare is regressing, repeatedly falling back on legacy interfaces and proprietary APIs that undermine the progress that standards-based data exchange was meant to achieve. This stagnation increases pressure on providers and harms patients by obstructing timely, coordinated care.
Healthcare organizations need to take a more strategic and assertive role in demanding open interoperability. Supporting SMART on FHIR, a data standard that enables applications to access information in EHR systems, and other standards-based frameworks is a great place to start. Also, avoid defaulting to closed, vendor-specific solutions. Policymakers should consider more impactful incentives, such as requiring interoperability for EHR certification, and enforceable penalties for entities that intentionally or unintentionally block data sharing. As AI and advanced analytics become more integrated into care delivery, the industry must have access to normalized, high-quality data. Interoperability is not a compliance checkbox; it’s a crucial enabler of better care, innovation, and health equality.
Vivek Desai, Chief Technology Officer of North America at RLDatix
One of the most prominent barriers to true interoperability in healthcare is siloed information. Despite the healthcare industry collecting more data than any other, disconnected systems and a lack of standardization force healthcare organizations to chase problems with fragmented data, duplicating efforts and slowing response times that hurt patients and staff alike. Eliminating data blocking and silos is key to addressing these hurdles head-on to ensure that health systems can access the insights needed to deliver safer, high-quality patient care.
A key step forward is modernizing IT infrastructure through strategic investment in modular platforms that unify critical functions. With the ability to connect key focus areas like safety, compliance, provider oversight, and experience, healthcare organizations can measure progress and scale more effectively. By breaking down data silos and using real-time, standardized data, they can further enhance interoperability and unlock insights needed to raise the standard of care within hospitals and health systems, while working to improve patient safety outcomes and reduce risk across the entire healthcare ecosystem.
Robert Duffy, Chief Technology Officer at HealthEdge
One of the biggest barriers to true interoperability is simply prioritizing what to integrate, when. Organizations that want to achieve seamless care coordination, reduce costs, and increase efficiencies need an interoperability strategy that’s based on both internal goals and external market factors. Without a comprehensive strategy in place that the organization is committed to, it’s too easy to become distracted, lose focus, or become paralyzed with competing priorities.
Within the payer business alone, there are numerous different systems that have historically operated in silos that will help with care coordination and the overall healthcare experience when they’re integrated. These range from systems housing clinical data to those for letters and correspondence, business rules, business intelligence, and even Social Determinants of Health (SDOH) data. Payers need to prioritize what’s most important and map out a plan to get there.
However, priorities aren’t always determined by what a payer feels is most important. External factors like regulations need to enter the equation too. For example, CMS is mandating Application Programming Interfaces (APIs) for prior authorization processes by January 1, 2027. Important requirements like this may shift internal priorities and have to be taken into consideration as they arise.
David Navarro, Senior Product Manager at Harmony Healthcare IT
One major challenge in achieving healthcare IT interoperability is organizing the vast amount of digital data generated throughout the patient care process. Without standardized categorization and formatting, sharing this data across systems for care, billing, or research becomes difficult. Many organizations use the FHIR specification to structure and exchange this data effectively.
Another key issue is determining what data should be shared. While the USCDI offers a starting point, many interoperability efforts require additional data elements. Organizations often develop custom specifications, like a Designated Record Set, to meet specific needs — requiring time, planning, and collaboration across stakeholders.
Bob Hackney, Chief Technology Officer at PerfectServe
Real interoperability in healthcare IT remains elusive because, to be frank, all (or at least most) of the incentives encourage data hoarding instead of data sharing. Vendors cling to proprietary formats to lock their customers in, and far too many health systems are trapped with aging technology infrastructure that was never built to play nicely with others. Until such time as interoperability becomes a requirement, rather than something that’s just nice to have, we’ll keep seeing half measures that fall way short of the progress we really need.
Standardization is another part of the problem. There’s momentum with FHIR, but inconsistent implementation and a lack of enforcement mean it’s still more of a loose framework than some kind of guarantee. We need to explore legislation that heightens the consequences. If your system doesn’t interoperate, it shouldn’t be certified. Period.
We need to align the incentives to make this work. Interoperability is a great, high-minded concept, but ultimately it has to deliver ROI for patients, providers, and vendors if it’s going to become a reality instead of a work in progress. Things like reimbursement, accreditation, and certification should be tied to measurable outcomes, and everyone needs to be held accountable. Unless that happens, we’ll have to keep patching systems together instead of solving the root problem.
Liz Lewis, Director of Product at Commonwell Health Alliance
One of the most significant barriers to achieving true interoperability in healthcare is trust—or more accurately, the lack of it. In a complex ecosystem of data exchange, it can be challenging to fully understand and trust all parties involved. While the technical capabilities to enable data exchange continue to advance rapidly, the ability to move data is only part of the equation. It is imperative that data requestors not only have the legal authority to access the information but also understand how to do so securely and in compliance with privacy requirements. Trust is built over time but can be broken in an instant.
As such, we urge the broader health IT community to actively seek opportunities to establish and reinforce trust. This includes strict adherence to HIPAA Privacy and Security rules, as well as ensuring that health information is only requested and used for purposes supported by appropriate legal and regulatory authority.
Coleman Young, Senior Product Manager at RXNT
The biggest challenge with interoperability is simple. Too many systems still don’t connect in a way that actually works for the people using them. Even with TEFCA making progress and QHINs beginning to emerge, a lot of practices are stuck with old, siloed technology that slows everything down. The first step is to choose systems that follow national standards and actually talk to each other. For example, using FHIR-based integrations or connecting through a QHIN makes it easier for your EHR to securely share patient records with other providers outside your organization. That kind of interoperability helps reduce manual work, cuts down on errors, and ensures patients receive better-coordinated care—especially when they’re seeing multiple specialists or switching providers.
Matt Ernst, VP Technical Ops & Support at Tendo
Key barriers include fragmented data systems, lack of standardization, proprietary vendor practices, and cultural resistance to change. Additionally, concerns around data security and ownership often stall progress. To overcome these, organizations need to adopt open standards, invest in API-driven architecture, and prioritize usability in integration workflows. Leadership alignment and incentives for outcomes-based care can also shift the focus from siloed operations to system-wide collaboration. Cross-industry coalitions and aligned incentives will be crucial to scale sustainable solutions.
Jeremy Friese, Founder and CEO at Humata Health
The biggest barrier to interoperability in healthcare is motivation. We’ve spent hundreds of billions of dollars on electronic medical records and health IT infrastructure, but we’re still far apart on true interoperability. Why? Because most of the use cases for interoperability have been focused on clinical needs that don’t directly involve money. We need to follow the money, because that’s what will ultimately motivate organizations to act more quickly. Interoperability needs a financial motivator, and we have one – it’s prior authorization.
Interoperability is key to automating prior authorization and making it fast and efficient so patients get the care they deserve more quickly.
The administrative burden and associated cost of prior authorization for both providers and payers are immense. But what’s even more motivating is that prior authorization is directly tied to payments. That’s why providers and industry groups like the AMA, payers and industry groups like AHIP, and the government at both federal and state levels have all been very vocal and active about solving prior authorization. Everyone is motivated to solve prior authorization, so they’re willing to sit down and work together towards solutions. It’s an issue that can break the interoperability logjam. Once it does, we’ll be able to use the foundational infrastructure and lessons learned to push interop forward in other critical areas.
Pete Srejovic, Chief Product & Technology Officer at Intelerad
Entrenched data silos, multi-vendor environments, and a lack of universally adopted data-sharing standards are the main sources of barriers to interoperability in healthcare IT, particularly in radiology and medical imaging. Legacy systems often operate in isolation, with radiology, cardiology, and other clinical specialties using separate workflows, archives, and tools. This fragmentation increases operational costs, hinders interdepartmental communication and coordination, and leads to delays in diagnoses and the delivery of value-based care.
Transitioning away from proprietary, vendor-locked systems toward cloud-based solutions is a key step in overcoming these barriers. Cloud technology enables secure, scalable image sharing and remote access to enhance effective collaboration among radiologists and clinicians, regardless of location or department. Also, healthcare organizations should prioritize the adoption of interoperable platforms, such as enterprise imaging systems and PACS solutions that unify data across departments. By embracing interoperability and cloud innovation, health systems can reduce complexity while improving clinical workflows and patient outcomes.
Anish Arora, Vice President of Product at TigerConnect
One of the most persistent barriers to achieving true interoperability in healthcare isn’t disconnected systems — it’s disconnected people. While healthcare IT leaders have made significant progress toward data-sharing standards, many hospitals and healthcare systems still rely on outdated communication methods like pagers, phone trees, and siloed emails. These channels delay care decisions and increase provider burnout.
To truly unlock the benefits of interoperability — better patient safety, more secure data exchanges, and faster innovation — organizations must prioritize integrated communication and collaboration. Fragmented workflows can be bridged by pulling in data from EHRs, labs, imaging systems, nurse call, schedules, and patient monitoring platforms and delivering it instantly via secure text, voice, or video right to a clinician’s mobile device. When communication and data flow together, it speeds decisions, streamlines discharges, and improves patient outcomes. Interoperability is as much about connecting care teams as it is about connecting systems, and that starts with unified communications.
Kevin Erdal, Managing Director & Practice Lead – Digital Health at Nordic
The barriers to a better healthcare system are cultural and organizational, not technical. Research shows that the top obstacles to healthcare interoperability aren’t insufficient APIs or software systems. The real challenges can be found within the cultures of healthcare organizations themselves. Misaligned incentives, competing governance priorities, one-off technology solutions, and a compliance-as-checking-a-box mentality are significant hindrances that many organizations struggle to solve. Executives who pursue a multi-pronged strategy to shift cultures and align initiatives with internal values will achieve the true intent of interoperability—simplified healthcare interactions that lead to better care – and will be better positioned to lead in their industries.
Stephen Vaccaro, President at HHAeXchange
One of the primary barriers to achieving true interoperability in home- and community-based services (HCBS) is the widespread fragmentation of data across disjointed platforms that don’t communicate with each other. Agencies often rely on a mix of single-point solutions like scheduling tools, billing software, and EVV systems, which create digital silos and isolate valuable insights. This lack of integration leads to inconsistent client records, time-consuming manual workarounds, and limited visibility into the delivery of care — ultimately weakening outcomes, increasing administrative work, and widening care gaps.
Overcoming these barriers requires the adoption of centralized data aggregation platforms that unify information from disparate sources into a single, accessible system. Tools that standardize data and documentation while reducing compliance risks will help to lay the groundwork for future-ready strategies such as AI-driven risk prediction, value-based care alignment, and real-time communication across the care continuum. By investing in interoperable, cloud-based technologies now, HCBS providers and managed care organizations (MCOs) can improve efficiency, transparency, and member-centered outcomes in the long run.
So many incredible insights here! Huge thank you to everyone who took the time out of their day to submit a quote 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.
What do you think are the main barriers to achieving true interoperability in healthcare IT? How do you think organizations can overcome them? Let us know over on social media, we’d love to hear from all of you!
About DJ Oreb
About Thomas Ritter