Nationwide Healthcare Interoperability Isn’t Happening

I’ve got interoperability on the mind today. I think it’s probably because of all the tweets that are coming out on the #InteropForum hashtag from the ONC Interoperability Forum in DC. I would have liked to attend, but I’m grateful that so many people are sharing what’s happening. That said, I must admit that I’m tired of a lot of the tweets that aren’t grounded in reality and that call for things that are never going to happen or tweets that propose goals that aren’t meaningful (yes, I had to use that word).

The first reality that’s become clear to me is that nationwide interoperability of healthcare data isn’t going to happen.

It’s just not going to happen and in most cases it shouldn’t happen when you consider the costs and benefits. Sure, we are all traveling a lot more, but there are 45 or so states in the US where no healthcare organization has need for my health information. If they do, then there are ways they can get it, but they are rare. Even if I have a crazy medical incident in an unusual state, those care providers know how to take care of me even without all my health records. Doctors are always treating patients with limited information. If I’m a chronic patient where certain information would be important for me if I’m treated out of state by a doctor that doesn’t know me, there are hundreds of options for me to carry that information on my phone.

My point here is that there aren’t any massive economic incentives for there to nationwide sharing of health data. Don’t be confused though. I’m not saying that sharing health data is not beneficial. What I’m saying is that we don’t need to build a national framework of health data sharing. When people suggest we should make that a reality, they’re essentially dooming interoperability. Talk about biting off more than you can chew. It’s become quite clear to me that Nationwide Interoperability of health data isn’t going to happen.

I love this excerpt from Brian Mack’s blog post on the Great Lakes Health Connect (an HIE) blog:

The Trusted Exchange Framework and Common Agreement (TEFCA) released by the Office of the National Coordinator last January, was (it was thought) intended to bring clarity and define a path forward for national interoperability, but has instead just added more uncertainty and the promise of additional layers of bureaucracy.

Discussions around national healthcare interoperability just bring more uncertainty and more layers of bureaucracy. It’s a failed approach.

With that said, it’s also very clear that smaller scale interoperability is not only possible but a valuable thing for most in healthcare. This was highlighted by interoperability expert, Greg Meyer, when he tweeted:

It’s really great that Greg is trying to figure out how we can generalize these point to point interoperability solutions. That’s a smart approach. However, buried in this tweet in a way that most will miss is the fact that there are a lot of unique scenarios and solutions where healthcare interoperability has been successful. Healthcare interoperability is possible and many organizations are doing it. Just not on a national scale.

To continue Greg’s analogy, we need more of these interoperability “snowflakes” and we need those creating the snowflakes to share their successes. A blizzard of snowflakes is a powerful thing even though the individual snowflakes are small. As it stands today, a national approach to interoperability is more like spending millions and billions of dollars on a snow making machine and then never turning it on. I’d rather have a million snowflakes than a billion dollar machine that doesn’t produce any snow. </ end snowflake analogy>

Another example of healthcare interoperability in action was shared at the Healthcare IT Expo this year. Don Lee offered a great summary of UPMC’s success with interoperability and the parts of interoperability they have solved. There’s always still more work to do, but if every hospital was able to accomplish what UPMC has accomplished in regards to healthcare interoperability, then we could have a very different discussion around healthcare data sharing.

The only solution I see to healthcare interoperability is for healthcare organizations to make it a priority. As I said back in 2013, Interoperability Needs Action, Not Talk. The more small interoperability connections we make, the more we’ll understand our data, how to connect, and build relationships between organizations. All of that will be key to even starting to thinking about nationwide healthcare interoperability. Until then, let’s table the nationwide healthcare interoperability discussions.

About the author

John Lynn

John Lynn

John Lynn is the Founder of, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • I’m pretty sure that a fax machine on Long Island can exchange documents with a fax machine in Honolulu with no problems whatsoever.

  • Great point Dennis. I actually included talking about Fax Machines as I started to write this post and then I realized there was a lot more to say. So, watch for my next post talking about the much-derided fax machine.

  • Hey John,

    I certainly agree nationwide interoperability is probably a myth. But as you suggest, maybe that’s not such a bad thing.

    For example, I’ve been getting care across my region (northern VA) for decades. Most of that care has come directly from the largest local hospital system, and virtually all of the other providers are affiliated with the system in some way.

    I’ve had little trouble getting records from one point to another given that the health system has a single Epic platform in place. So there you have a local solution, at least one that works in a suburban environment. (I realize things might be much different in a rural setting.)

    So what if I end up getting sick in another state or country? Given that I’ve never faced this problem in 52 years, I don’t worry about it. But if I did get ill when traveling, faxes would usually do the job. And if I have conditions ED doctors should know of, a Medic Alert bracelet would do the job in many cases.

    So, local sharing good, national sharing seldom needed.


  • Seems to confirm my point that US Health IT currently is where US telecommunications was in the 70s and beyond. Major players have no interest opening up their systems. Consequences for patients and independent practitioners be damned.

  • I totally agree with you up to your last sentence. “Until then, let’s table the nationwide healthcare interoperability discussions.”
    Maybe we are looking at #interoperability from a paradigm that is wrong. We used to have a technology strategy to solve this major problem. It failed miserably as you described. If you have a paradigm shift, a new culture, which is currently promoted by CMS. This is a revolutionary paradigm which is- people centered can and will solve ALL our problems with #EMR at a much lower cost. Please check

  • Hi Gergely,
    A people centered solution still won’t really be nationwide interoperability. That aside, people centered is a great option for those who truly care about their health. The problem I’ve seen across hundreds of similar startups is they find that most people don’t really care. They pay lip service to caring, but their actions say otherwise. The exception is some chronic patients. I say some chronic patients, because many chronic patients are in denial and so they choose not to care too until they come out of denial.

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