Interoperability in Hospital Care: Achievements, Challenges, and the Path Forward

The healthcare industry has made notable progress in its long-standing goal of achieving interoperability—the ability to securely exchange electronic health information across organizations, systems and platforms. Spurred by policy, technological innovation and cross-sector collaboration, hospitals and health systems are closer than ever to realizing a fully connected ecosystem. Yet challenges remain, and continued progress will depend not just on infrastructure but on shared governance and trust.

Milestones and Momentum

The 21st Century Cures Act, passed in 2016, set in motion a wave of regulatory reforms to promote interoperability and discourage information blocking. The Office of the National Coordinator for Health Information Technology (ONC) followed with rules that empower patients to access their records and require hospitals to share data using standardized formats.

A major enabler of this shift has been the rise of Fast Healthcare Interoperability Resources (FHIR), a standard developed by HL7 that allows diverse health IT systems to exchange information in real time. Meanwhile, networks like Carequality and the CommonWell Health Alliance have allowed providers to access and share patient data across institutions and electronic health record vendors.

These initiatives have laid critical groundwork for enabling care coordination, supporting public health reporting, and improving outcomes.

Persistent Challenges

Despite this momentum, barriers to full interoperability persist:

• Technical Gaps: Smaller or rural hospitals may lack the funding or staff to keep pace with integration demands or adopt the latest interoperability tools.

• Inconsistent Data: Variations in coding practices, documentation, and system design can make data difficult to interpret or use, even when technically exchanged.

• Trust and Legal Concerns: Health systems often operate in different legal jurisdictions with varying policies around data privacy, consent, and liability—creating hesitation around data sharing.

• Workflow Friction: Data access alone is not enough; it must be surfaced within clinicians’ workflows in a way that adds value, not burden.

  
  

The Role of Shared Governance and a Third-Party Convener

One promising model for overcoming these barriers is the use of shared governance frameworks led by neutral third-party conveners. These organizations—such as health information exchanges (HIEs), regional health collaboratives, or national policy bodies—act as impartial coordinators among stakeholders.

By establishing common rules of engagement, third-party conveners can:

• Develop standardized data-sharing agreements that reduce legal friction.

• Facilitate trust frameworks to ensure consistent privacy and security practices.

• Bring together competitors to align on technical and operational standards.

• Coordinate governance across systems, vendors and jurisdictions to enable scalable interoperability.

A clear example is the Trusted Exchange Framework and Common Agreement (TEFCA), a federal initiative administered by The Sequoia Project as a Recognized Coordinating Entity (RCE). TEFCA’s aim is to unify disparate networks under a single set of policies and technical standards, enabling nationwide data exchange through Qualified Health Information Networks (QHINs).

Without shared governance, interoperability risks becoming fragmented, with each entity building its own solutions in isolation. A trusted convener helps shift the focus from proprietary interests to collective value—ensuring interoperability works for providers, patients and the broader health system.

What’s Next?

Looking forward, advancing interoperability will require continued investment in not only technology, but in partnerships, policy alignment and stakeholder engagement. Areas of emphasis include:

• Widespread adoption of FHIR and other standards that support structured data exchange.

• Improved data quality and consistency to ensure meaningful use of shared information.

• Greater use of shared governance models to resolve cross-organizational challenges.

• User-centered design to ensure interoperability tools support clinical decision-making.

The future of hospital care will be shaped by the ability to exchange data securely and effectively—across systems, settings and communities. With collaboration, trust, and shared purpose at the center, interoperability can fulfill its promise of safer, smarter and more coordinated care.