Transforming patient data into better outcomes

Beyond compliance: Rebalancing the supply and demand for patient data

Healthcare generates enormous amounts of data, from  electronic health records, and claims data to pharmacy data, wearable data, and more. The supply of information is not the problem.

Connectivity is.

For years, interoperability has been treated as a technical challenge. But the technology largely exists. Standards exist. Secure exchange frameworks exist. What remains unresolved is alignment, meaning the incentives that determine whether data moves or stays siloed.

When information cannot move easily between systems, clinicians work without a complete picture of their patients. Patients repeat tests because records do not follow them. Care teams spend time searching for information instead of using it to guide care. We tolerate a level of friction in healthcare that would be unacceptable in nearly any other part of our lives.

Consider if our banks operated this way: If we could not easily access financial records or authorize information to be shared, most of us would switch banks. Yet in healthcare, fragmented data exchange has long been treated as normal.

The result is a system that is far more complex than it needs to be.

The current state: Three barriers to meaningful interoperability

Despite years of progress on standards and policy frameworks, three structural barriers continue to limit how effectively patient data can move across the healthcare system.

1. Market concentration creates unequal access

Healthcare data concentration has reached a tipping point, with a small number of major EHR vendors controlling the majority of acute care hospitals in the United States, creating classic market dynamics where large health systems can negotiate comprehensive data sharing agreements while independent practices — still serving millions of Americans — find themselves with limited access to the patient insights that could improve care.¹

This concentration creates innovation bottlenecks. When comprehensive datasets are inaccessible, new AI tools, and predictive analytics platforms, and patient engagement solutions deliver suboptimal results that reinforce existing limitations.

2. Supply abundance meets access scarcity

Consider a family practice trying to launch a program to better manage their patients with diabetes. They want to identify patients at risk for complications, track how treatments are working, and coordinate care with specialists. Connecting these systems requires separate contracts, custom technical work, and substantial ongoing costs that scale with program complexity.

Meanwhile, time-sensitive opportunities slip away. A patient’s glucose spike from last week’s lab work can’t inform today’s appointment if systems don’t communicate. Care coordination becomes reactive rather than proactive, and, without comprehensive data, AI tools that could suggest potential complications aren’t put to use.

3. Innovation happens despite infrastructure, not because of it

Every barrier to data access compounds across the system: delayed diagnoses due to incomplete histories, duplicated tests because results can’t be shared efficiently, and care gaps when providers can’t see patients’ complete health journeys.

The innovation impact is equally significant: Breakthrough solutions remain confined to well-resourced systems, while many providers and patients miss advances that could improve care quality, reduce costs, and enhance the overall healthcare experience.

Breaking down the barriers

Regulatory frameworks like the 21st Century Cures Act have established baseline interoperability requirements and prohibited information blocking practices.² The Trusted Exchange Framework and Common Agreement (TEFCA) builds on these foundations by establishing a universal framework for secure health information exchange across networks, moving beyond fragmented point-to-point connections. Yet, three challenges prevent meaningful interoperability:

Moving beyond minimum compliance

Many organizations take a compliance-first approach, implementing technically compliant but complicated data sharing mechanisms. As result, patients gain access to records in formats that are difficult to understand or share — meeting regulatory standards while maintaining barriers to innovation and care coordination. Real progress happens when organizations ask, “How can we help patients?” instead of, “What do we need to do to comply?”

Navigating business model transitions

Healthcare organizations face challenges transitioning from traditional business models where patient data was viewed as a competitive asset to open sharing approaches. This shift requires significant cultural and operational changes that take time to implement effectively.

Some practices implement approaches that meet regulatory standards but inadvertently create barriers — such as fees covering legitimate costs that discourage requests, or security processes that slow data access. These challenges often stem from understandable business realities as the industry works through a transformation extending beyond individual organizations to entire market dynamics.

Technical standards exist, but mindset gaps remain

The healthcare industry has made remarkable progress developing technical standards. FHIR provides a robust framework for exchanging health information, and most major EHR systems support these standards. The technical infrastructure largely exists.

However, technical capability doesn’t guarantee practical implementation. Many organizations implement APIs that meet requirements but limit functionality through business rules, or access restrictions. Until healthcare resolves the tension between data sharing and competitive positioning, technical standards alone won’t deliver seamless interoperability.

Patient-directed data: Where innovation happens

A new dynamic is emerging: patients taking control of their healthcare data. When individuals become active stewards of their information, they transform healthcare from fragmented encounters into connected, patient-centered experiences.

Patient-directed data sharing means individuals use secure platforms — whether patient portals, health apps, or integrated personal health records — to gather complete health information from multiple sources in one accessible location. They decide which providers get access to which information and when. When patients control their data and can easily share it with any provider, healthcare organizations must compete on clinical outcomes, patient experience, and care quality rather than information silos.

athenahealth’s network perspective

We’ve witnessed the evolution from data silos to sharing among our provider partners. When Christopher Ketchie joined Beaufort Hospital as VP of Physician Services, he found “one EHR in three-quarters of our practices, and a different system for our large multi-specialty group.” Ketchie adds, “They didn’t integrate. It was hard to track anything or understand our business.”

After transitioning to athenaOne®, Beaufort discovered how better data sharing leads to better patient outcomes, which drives practice growth. As Ketchie explains, “Getting that complete picture of each patient helps us take care of them better. We can more effectively manage care so that they don’t end up back in the ER.”

Results for Beaufort include 40% patient portal adoption, 30% increase in patient registration rates, and successful expansion to serve previously underserved rural communities. The hospital now benefits from network-wide insights. “Having access to knowledge and best practices from thousands of other organizations on the network keeps us efficient and informed,” says Ketchie.

Building the open healthcare network

True innovation requires shifting from closed, control-based systems to open, outcome-focused networks. The future belongs to organizations that understand connected data drives competitive advantage. When patients can freely direct their information and providers compete on outcomes rather than access, healthcare transforms from fragmented silos into an innovation-ready ecosystem where value flows as freely as the data that creates it.

Explore how athenahealth is helping build a more open, connected healthcare ecosystem.