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"It should be easy." If you've dealt with interoperability in healthcare at any point within the past decade, that thought has probably crossed your mind at least once. Innovation and ingenuity have led to software that can chat with you like a human, transmit money to a bank account across the globe, and track a package from the warehouse to the front door. But in healthcare, it can be a struggle simply to pass a consolidated clinical summary from a referring provider to a specialist. In my mind, there are three key reasons why healthcare interoperability remains challenging.

##### Availability

Healthcare technology didn't begin with a culture of interoperability. That's understandable, given that we can trace health information management systems back to the 1960s when the industry was truly entering uncharted waters and our technological capabilities were far more limited than today's. Integrations have been added as business needs arose and standards were defined, but I would argue this bias towards interoperability as an add-on rather than an intrinsic feature slowed its progress.

Even now, the culture of interoperability is nascent and the availability of integrations is incomplete. HL7v2 interfaces are widely supported by EHRs and ancillary systems, but their publisher-subscriber model and lack of inherent security make them ill-suited for modern web applications. API coverage is growing, but among the major EHRs such as Epic and Cerner, the majority of APIs only support pulling data out, not pushing data in, and only for a single patient at a time. Most EHRs, payers, and clearinghouses don't advertise direct database access for advanced data extraction and analytics. And high costs to integrate—which I assert is common throughout the tech industry—can make available integration methods de facto inaccessible.

##### Complexity

Healthcare is difficult to distill down to ones and zeros. For one, it is ubiquitous across the globe, which means that healthcare integrations must accommodate the enormous variety of cultural differences. Take something as basic as a patient's name; in the Western world, we are accustomed to a pattern of first names and family names, with most people also having a middle name. How then to interoperate with software designed for a totally different region, such as Ethiopia where [patronymics](https://en.wikipedia.org/wiki/Patronymic) dominate instead? Street addresses provide comparable challenges across borders, yet true interoperability can't function only for Western standards.

Secondly, meaningful healthcare data encompasses an array of data points, types, and formats. There are discrete values like vital signs that boil down to a number with a unit of measure. There are free-text strings ranging from a brief reason for a visit to lengthy rich-text notes. There are images, PDF documents, code sets, and more, some of which could be intensely private or critical for patient care. It isn't like integrating with Google Maps, where a few details about your origin and destination results in a mundane set of driving directions. Healthcare is a reflection of the realities of life, and life is complex.

##### Fragmentation

This factor is the most difficult one to overcome, in my opinion. If healthcare IT is a jigsaw puzzle, modern interoperability is trying to put it together only to realize several pieces don't fit. You might perfect one or two corners, but the full picture can't be seamless.

In healthcare we rely upon a vast number of systems and data repositories, from EHRs to ancillary lab and radiology systems to public health registries and others. No two software applications or databases have the exact same data points and in the exact same format. Not one is an authoritative data source for a majority of patients (at least, not unless Oracle can truly pull off a national health records database—but I digress).

Compare this to, say, developing smartphone apps, where Apple's iOS and Google's Android have cornered the market. To make my app work, I only need to code to the standards of two platforms, and as those standards evolve, I can make updates that work for all users at once. Admittedly I'm oversimplifying—there are aspects such as OS versions to consider—but the permutations are still more limited, and the points of integration will remain the same whether my user is in Jakarta or Jackson Hole.

We simply don't have this luxury today in healthcare technology and we may never enjoy it. No doubt industry standards such as HL7v2, ANSI X12, and FHIR help reduce the complexity of integrations, but they don't eliminate the need for understanding and adapting to the nuances of each source and destination system, which is a time-consuming chore. This will always be a source of friction in the race to build an interoperable healthcare network.

##### Speed limits remain

The struggle is real. Healthcare could very well be the only industry in the U.S. where the federal government has had to mandate a minimum data set that must be exchangeable through APIs and to specify rules to prevent information blocking. To me, this speaks volumes to how challenging healthcare interoperability remains and how far we have to go. I can't say with certainty where the finish line lies, but I can say the journey isn't easy.

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Photo by [Alexas_Fotos](https://pixabay.com/users/alexas_fotos-686414) on [Pixabay](https://pixabay.com)


Learn about the three key reasons why healthcare interoperability remains challenging

Why interoperating in healthcare is hard - Nonstop Interop

Why interoperating in healthcare is hard

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##### ![Composite of a man's silhouette composed of numbers and letters and a man forging metal with a hammer](/images/Silhouette-of-man-and-hammer-forging-metal-1654491600.png)

##### Welcome

Welcome to Nonstop Interop and its first post! We’re excited to have you and to share our perspective on healthcare technology and the interoperability landscape.

I crossed the threshold into healthcare IT a decade ago, thinking I would stick with it for two or three years and then move on to greener pastures. As it turned out, the pastures in Verona, Wisconsin—and within the industry—proved to be more magnetic than planned.

I have a lot to be grateful for from the past decade—the wonderful people I’ve met, the cool places I’ve visited, the immense knowledge I’ve gained—and I hope Nonstop Interop is one way to offer the best portions to you. Thank you for making us a part of your world.

##### At the core

There is arguably no hotter topic in healthcare technology than interoperability. Numerous entities—from payers to technology companies to governments on multiple continents—are on a mission to make connected software and information networks ingrained into healthcare IT.

But interoperability is more than a buzzword. I wouldn’t characterize it as a trend either, because the word implies that its popularity and emphasis could wane in the future. To me, interoperability is a necessity, a rule of the road that is fundamental to 21st century healthcare.

Despite this, I admittedly catch myself sometimes questioning why interoperability is so important. Why does it matter if a technology startup with a new app can’t write recent vital signs into a patient’s electronic record? Which real-world problems actually arise when U.S. hospitals don’t provide pricing information in a machine-readable file as required by CMS?

Over time I’ve come to believe that interoperability’s value boils down to two key things: data and power. These two elements best capture the potential energy within interoperability, and they are fueling the explosion of integrations, standards, innovation, and regulation within our industry.

##### Data

Of these two core elements, the importance of data is more obvious in my mind. Data is the lifeblood of interoperability; the latter could not exist without the former. Imagine if a farmer tried to irrigate their fields while lacking any water. They could build all the pipes and connect all the pumps, but if there are no molecules of H2O to move from point A to point B, there's no irrigation.

Likewise, data is what gives interoperability a sense of worth. Organizations we work with at Ashavan often evaluate integration options in terms of the data points that they need to feed an algorithm or support a workflow. Acquiring a set of data means these organizations are acquiring knowledge that would otherwise be hidden from view and potentially underutilized, and that knowledge enables them to take meaningful action.

##### Power

This leads me to power. I’ve debated whether other factors such as money or transparency were more crucial, but in the end I feel power is the foundation upon which those stand. The siloed and independent nature of legacy health information systems meant that strength accumulated to those who held the most data, but interoperability diminishes that rule and provides a way for every stakeholder within healthcare IT to challenge the status quo.

With interoperability, technology companies of all sizes realize the power to create innovative products that could enable faster and higher quality experiences for users. Patients earn the power to participate in their own care and to ensure they can share their health information with whomever they want. Care coordinators and researchers gain the power to see the full breadth of a patient’s healthcare journey and better identify helpful interventions. The power at the heart of interoperability multiplies the potential within healthcare.

##### Wrapping up

Yes, interoperability is essential to modern healthcare. The ability to unlock data from repositories large and small empowers us to innovate and communicate more effectively, and while interoperability doesn’t guarantee better health outcomes for everyone, it does give us the power to move closer to that goal.

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Photos by [Amirhossein Azandarian Malayeri](https://unsplash.com/@mr_brightsides) on [Unsplash](https://unsplash.com) and [J.MT Photography](https://www.pexels.com/@j-mt_photography-628996/) on [Pexels](https://www.pexels.com)


Hear from our Founder and CEO on why interoperability comes down to data and power

Interoperability is all about data and power - Nonstop Interop

Interoperability is all about data and power

Nonstop Interop is a when-the-moment-feels-right blog focused on interoperability and data integration within healthcare. Our goal is to provide educational and insightful content for technical and non-technical audiences.

Nonstop Interop

Satellite image of lights in the United States at night

Nonstop Interop is a when-the-moment-feels-right blog focused on interoperability and data integration within healthcare

Our goal is to provide educational and insightful content for technical and non-technical audiences. Please forgive any digressions, bad analogies, or shameless self-promotion.

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