Healthcare Interoperability and why should you care (as a patient)

Anish Arora

Much has been said and written about Interoperability (or lack thereof) in healthcare. It is no surprise that any grand idea in healthcare these days involves sharing data assets across boundaries and almost inevitably Interoperability becomes the elephant in the room. As a former employee of Epic and someone who has been working on the frontlines of what I like to call “connect-the-dots” for several years with various healthcare organizations (HCOs), startups, vendors, to deliver innovation that providers and patients desperately need and deserve, I deal with these challenges day in and day out.

EMR vendors have borne the brunt of the blame for being self-centered and developing products with a complete disregard for interoperability. Policymakers have been chastened for not doing enough and lacking vision (like betting too big and too high on HIEs and doing almost nothing for Interoperability). HCOs have borne the blame for not being vocal enough to influence vendors and Washington.

While all this three-way finger-pointing between vendors, HCOs, and policymakers has been going on, another significant change in the healthcare marketplace has taken place – the evolution of you, the patient, as a super-empowered consumer with very vastly different expectations of your healthcare provider than your parents had. It’s astonishing to see how the patient has evolved in the last several years from being shoved around a complex healthcare system at the mercy of doctors and insurance companies to a more educated and savvy consumer of health services and products. Today’s patient wants a seat at the table that has traditionally been occupied by providers and payors. Today’s patient has valuable data to offer about his health.  Today’s patient wants to be “connected.”  

All of this means that in the future (already happening) we should see a lot of demand for mobile apps and connected devices (IoTs – sigh!) delivering healthcare.


According to CCS Insight’s Global Wearables Forecast, 185 Million fitness, activity, and sports trackers will be sold by 2021.

Besides, with technologies like Artificial Intelligence, Machine Learning, and Voice going mainstream the possibilities in healthcare seem endless. Go to any consumer healthcare conference these days, and you can expect to see a dazzling array of stalls with vendors touting fancy devices and mobile apps. It’s a wonderland.

Not too long ago, vitals like heart rate, blood pressure, etc. were something recorded only in the doctor’s office. A laboratory conducted blood and urine tests on samples you provided. Sleep clinics where you had to spend the night evaluated you for sleep disorders. Today, while all of those things are still relevant, our smartphones, smartwatches, fitness trackers, weighing scales, and even toilets! Are collecting similar data round the clock. They are telling us when to exercise, when to sleep, what to and what not to eat. They are tracking every heartbeat. Now more than ever patients are asking their doctors the tough questions –

“how does this plethora of data pertain to my chronic diseases?”

“How is this data relevant to the management of my conditions?

“How can you (my doctor) use it to deliver better care for me?”

In other words,  patients are now asking questions about Interoperability even though they do not know it!

Here’s the bad news: Your doctor doesn’t have an easy answer

The fact is that integrating these gizmos into mainstream healthcare delivery is nothing short of a nightmare and your doctor is as much a victim as you are.

As a patient, the EMR vendor and technology deployed by your HCO and other limitations of your HCO dictate how well connected you are with your doctors and the system.  

The EMR vendor has little incentive to build technology that allows easy sharing of data with other vendors – they are too busy trying to capture what’s left of the EMR market share and trying to expand their product line offerings.

Don’t get me wrong though there are indeed some decent mobile apps today that allow you to schedule office visits, refill prescriptions, access immunization records, and even conduct telehealth visits. Some also work with your Apple health kit and fitness trackers. However, once you open the hood, it’s no surprise that most of these apps are a rebranding of apps provided by the HCO’s EMR vendor or a third party that partners with the EMR vendor. The apps tightly integrate tightly with those EMR systems.

As long as you’re within the HCO its all fine but try moving from one HCO to another and ask for your medical records – chances are you will be waiting for weeks and eventually handed a 5-pound stack of paper. Your new provider might request a “CCD” (Continuity of Care Document) that is supposed to seamlessly transfer your medical record from one EMR system to another, but chances are it won’t be as seamless as you would expect.

In other words, there is innovation that patients can use, but boundaries outlined by the EMR vendor and the HCO dictate what you can and cannot do. It is inevitable that these barriers will be tested to the limit soon. With the explosion of consumer health devices and apps, more educated and tech-savvy patients, and increased pressure on the entire healthcare system to cut down costs, the demand on EMR (and other) vendors to be more Interoperable is growing every day.  To prepare for the mobile and IoT revolution in healthcare here are the top 3 that need to change with regards to interoperability fundamentally:

  1. 1. Recognize that Interoperability is a problem that has to be ultimately solved by the Industry, not by policy. The HITECH Act and Meaningful Use programs have been instrumental to some extent in fueling the market for EHRs and to ensure that EHRs bring value to the table. However, depending on these programs to take healthcare delivery and patient engagement to the next level will be a costly mistake.


  1. 2. EHR vendors need to have a substantial incentive to open up their platforms for patient engagement solutions. This one is the hardest nut to crack in my opinion. Some experts believe it could come through reimbursement models where for example patient’s electronic interactions with the healthcare system are incentivized. Opening up platforms not only means offering more web services and integration capabilities but also to enable them as development platforms where third-party developers could develop their integration solutions.


  1. 3. The traditional unilateral provider-patient relationship is changing, and HCOs need to understand it. The balance is slowly shifting from providers to patients, and that’s not necessarily a bad thing – patients in control are healthier patients and help bring down the cost for everyone. It’s like your child growing up to be a teenager – more informed, more independent, but still needing you as much to lean on. You now need to be less parent and more friend to help them make the right choices. HCOs need to be more vocal and assertive in asking EMR vendors to be more like platforms that fuel and foster innovation so that their patients can have options to engage with the system in a more meaningful and efficient way.

Closing thoughts:

The empowered patient is a game changer for healthcare. We are entering into a consumer-driven revolution in healthcare like never seen before, and I hope that this will shine the spotlight on Interoperability more brighter. The EMR vendors and HCOs who will survive this revolution will be the ones that are genuinely patient-centric and not just claim to be patient-centric.

about the author

Anish Arora

Anish Arora is a healthcare IT strategist and a leading proponent of ”API fueled innovation”. After having worked at Epic for several years, he founded his consulting practice to deliver innovative integration solutions to healthcare provider organizations, vendors, and startups. Anish holds a Bachelors Degree from the Delhi Technological University and an MS from the University of Illinois at Urbana Champaign. He is also pursuing a program in Healthcare Analytics at the University of California, Davis.