The following is a guest article by Effie Carlson, CEO at Watershed Health
The Problem Is Not Only Data Availability, It’s What We Do With It
Federal mandates and billions of investment dollars have pushed the healthcare industry closer to interoperability. On paper, it appears to be far along, but in reality, mountains of data are producing molehills of action.
Health information exchanges (HIEs) are humming along, and electronic health records (EHRs) are interacting across state lines, yet patients are still falling through the cracks in the most fundamental ways, particularly around transitions of care. The patient data exists to avoid things like hospital readmissions, but it’s never prompting anyone to act.
Consider a senior with diabetes and kidney disease who leaves the hospital with a clear plan: a 48-hour lab check, adjusted medication doses, and follow-ups with primary care and nephrology. All of this information is in the EHR, could be exchanged in an HIE, and is technically available across systems. But nothing turns into an actual task. The lab order never triggers the PCP. The nephrologist’s appointment alert sits unread. The medication change and dosing warning sit buried in an EHR note. Three days later, he’s back in the emergency department with acute kidney injury. The data never became a plan because there was no way to consistently action across settings.
The problem in our industry is not just technical. It’s operational. Healthcare has confused having data with “actioning” that data into workflows for better outcomes. We must acknowledge this gap in care and take deliberate steps to close it; otherwise, interoperability will remain an ineffective and expensive half-victory.
The Interoperability Paradox
Federal mandates have delivered on their technical promise; recently, Health and Human Services (HHS) announced that nearly 500 million health records have been exchanged through the Trusted Exchange Framework and Common Agreement (TEFCA). Information-blocking laws give teeth to the mandate that data should move freely. Standardized APIs allow systems to pull patient records across platforms without custom integrations, and electronic health records (EHRs) talk across state lines. By many measures, interoperability is alive and well.
But data availability and exchange are not the same thing as “actionable” data. The framework was primarily built for hospitals, leaving skilled nursing facilities, home health agencies, and community-based providers on the sidelines. Not every organization is well-resourced and digitally mature; many post-acute providers still rely on paper-based workflows and manual processes like fax and phone. It treats milestones like admission, discharge, and transfer (ADT) alerts as the finish line when, in reality, they are the bare minimum in the continuum.
Solving for the Action Gap
Healthcare must move to “specific people get specific intelligence,” with steps in the technology process that push action and monitor completion. From a technology perspective, specific characteristics entail:
- Contextual, delivering the right information to the right person at the right time
- Risk assessment and clinical judgment are built in and applied
- Role-specific, designed for actual clinical workflows rather than administrator dashboards
- Clear ownership so that every alert carries accountability
- Cross-team coordination with easy communication capabilities for real-time alignment
- Integrated into existing processes rather than adding steps or costs
- Closed-loop tracking of whether the action was completed
Most of these critical steps currently fall to manual processes like fax and phone, workarounds, or well-meaning but overwhelmed staff. This continues to be unsustainable and ineffective.
Healthcare Should Commit to Turning Data into Action
A three-pronged approach should be implemented. To healthcare technology companies, design for under-resourced settings, not just enterprise buyers, with a focus on the variability of real-world care. Workflow integration is paramount over complex features and flashy functionalities.
Healthcare organizations should evolve their strategy beyond data availability to measure data utilization effectiveness, turning information into action. The industry must invest in tools that serve the people delivering the care, not just managing it.
For lawmakers, the next iteration of interoperability must be focused on inclusivity and the action gap. Ways to do this include incentivizing more than data exchange by aligning incentives to actions that produce clear improvements. As for investments, infrastructure support is critically needed for post-acute, community-based, and rural healthcare entities that have been left behind.
The data is flowing, but the question is now whether the industry will “action” it for where the hardest work happens. Digital health technologies like care coordination platforms are ready to fill this gap and automate interventions in the care continuum.
Effie Carlson is the CEO at Watershed Health. She brings more than 16 years of experience in healthcare leadership, policy, strategy, and business development across the provider and payer sectors, and her experience spans managed care, healthcare technology, government relations, and value-based care. Carlson founded EJC Consulting Group and has served in executive leadership positions at Modivcare, PayrHealth, Team Select, and CareCentrix. Carlson is an active advisor and board member for healthcare organizations, including the Texas e-Health Alliance, SendaRide, and the Non-Emergency Medical Transportation Accreditation Commission (NEMTAC). Follow on LinkedIn.
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