Interoperability moves from talk to action

The water’s fine. It’s time to jump.

Growing up in the Southwest, summers meant Lake Powell — and Lake Powell meant jumping off cliffs. Not recklessly — you could see the water, you watched others go first, you knew it was safe. But you still had to make the decision to jump.

Being back in the desert for HIMSS this year brought that to mind. After years of talking about interoperability — the frameworks, the standards, the pilots — what I saw in Vegas felt like an industry finally deciding to go.

I sat on a panel with colleagues from Epic, Sutter Health, and Raleigh Neurology. We talked about referrals — the unglamorous, friction-filled, fax-riddled handoffs that happen millions of times a day between ambulatory offices and health systems. These are the handoffs where things get dropped, where patients fall through the cracks, where a clinician has to leave the workflow to make a phone call just to find out if a referral was even received.

We talked about 360X, a standard designed to make referrals more visible and more transactional by allowing status updates and supporting documentation to move with the patient. We talked about TEFCA. And we talked about what it actually feels like to build something that works across organizational boundaries — not in a demo environment, but in the real world, with actual patients, real staff, and real workflow constraints.

What struck me most was the spirit in the room.

I've been working in healthcare interoperability long enough to remember when “collaboration between competitors” was mostly a talking point. What I saw at HIMSS felt different. A specialty clinic director described how electronic referrals cut her team’s chart creation time in half — work that used to mean opening a fax, reading it, retyping it, and building a chart from scratch now happens in a single step. A large integrated delivery network described what it means to centralize hundreds of thousands of referrals across Northern California and actually get status visibility back. There was a shared acknowledgment that this only works if everyone — vendors, health systems, payers, and clinicians — shows up with the same sense of purpose.

360X is working. TEFCA is maturing. The referral that used to generate three phone calls, two faxes, and a lot of frustration is — slowly, imperfectly, actually — becoming an electronic loop that closes. That's not a pilot result. It's real.

That’s the good news. But here’s what the industry still needs to reckon with.

We are at an inflection point where the pressure to make interoperability real is colliding with some very entrenched incentives to keep data siloed. Despite federal policies pushing toward open data exchange, some dominant platforms have found ways to remain technically compliant while ensuring that data flows most seamlessly within their own networks — reinforcing the very lock-in that interoperability is meant to dismantle.

Federal policy over the past decade has pushed aggressively toward interoperability through the 21st Century Cures Act and information-blocking rules. But while technical interoperability has advanced rapidly, governance mechanisms have lagged behind. That's the next frontier.

The lawsuits piling up in federal courts right now — vendors suing each other over data access, state attorneys general pursuing antitrust claims against EHR giants, health data companies accusing each other of weaponizing interoperability frameworks as competitive tools — are a symptom of that unresolved tension. Expanding data exchange creates enormous potential for care coordination, analytics, and innovation. But none of that potential materializes if we spend the next five years litigating the rules of engagement instead of building what patients and clinicians need.

And yet, for all that friction, the people closest to the work — the clinic directors, the health system operators, the engineers on the ground — are past the debate. They’re not waiting for perfect policy or for every competitor to come to the table in good faith. They’re building and learning as they go.

It doesn’t work if only one vendor does it, or only one health system commits. At HIMSS, I saw signs of improvement. Progress is still uneven, and some of the hardest barriers remain, but more of the industry is starting to participate.

We’ve been standing at the edge long enough. The water’s fine — we know because we jumped.