Is EMR Interoperability A Pipe Dream?

In theory, interoperability between vendors offers the vendors some rewards.  In particular, by making in possible for customers to link up between their own and their competitors’ systems, they broaden the market substantially, as customers aren’t afraid of getting locked into a single solution.  Also, in theory interoperable systems are stronger than isolated sandboxes, as they share data in a way which benefits customers.

Unfortunately, though, the EMR market defies the usual logic of the enterprise software business, so much so that I doubt  we’ll see this generation of vendors even try to interoperate with their competitors:

Larger vendors have little incentive to connect:  The market’s leading vendors already have enough market share (it seems) that they can roll out a product based on proprietary technology and get healthcare CIOs to swallow it.  Some may even buy the logic of people like Epic CEO Judith Faulkner, who’s argued that adopting products from only one vendor is safer and more efficient.

Healthcare organizations are extraordinarily risk-averse:  Anytime an organization invests big bucks in software, EMR or not, they’re pretty damned careful that they’re getting it right.  In this case, that means going with the vendorvwhich has managed to win the heart of the C-suite. (In reality, that means that if they fail they fail spectacularly, across the board, but that’s a tale for another day.)

Open source alternatives aren’t much of a factor:  In theory, if open source alternatives were getting some footing, healthcare CIOs’ attitude might be different. Not only the technology but the culture of open source development would pretty much rule out creating a proprietary island around their EMRs.  But at present, the “big iron” vendors (such as Epic, Cerner and Meditech) are far, far ahead.

Standards are still malleable:  In theory, we have HL7, but it can be correctly implemented and still incompatible with other implementations.  Not sure how we’re going to fix that, but it’s definitely a major barrier to implementation all of its own.

HIEs are all over the map:  Maybe, just maybe, if an HIE vendor had a staggeringly large share of the market, EMR vendors would be forced to step to its tune and at least interoperate with that vendor’s technology, which could help things a great deal. But as things stand, to my knowledge, no one HIE player has been able to pull this off.

Now, if cloud-based EMRs grow more popular, there’s new possibilities for interconnectivity, but it probably won’t help the interoperability problem. Honestly, I doubt we’ll see much progress here until a new generation of EMR vendors is born. What do you think?

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • I agree but this article only mentions the significant technology hurdles. At a HIMSS conference one speaker talked about the reasons why providers use the technology differently. At least 4 different nomenclatures are taught in US schools so clinicians being their careers disagreeing on the most basic elements of how they practice. Even if technology comes together, as long as clinicians are putting different values in the fields then interoperability will remain unattainable.

  • Linde, I’m confident you’re right, but that’s not what Epic is saying. Your friend and mine, CEO Judy Faulkner, is claiming not only that Epic-to-Epic data sharing is easy, but that it will soon be easy for non-Epic systems to share with her platform. Perhaps she’s exaggerating just a bit?

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