Rethinking Healthcare Interoperability: A Strategic, Global, and Often Ironic Journey
Prepared by Vicerion Corp
Contributors: Shawna Koch Mishael, Head of Healthcare Strategy
Summary
Despite bipartisan support for patient ownership of their data, healthcare interoperability remains an elusive goal. As costs skyrocket and patient frustration mounts, we explore the structural, cultural, and financial barriers holding back semantic data sharing. Through a pragmatic and slightly ironic lens, this report outlines global trends, policy efforts, and the strategic recommendations needed for progress. Spoiler: it’s not about more middle-ware or intermediary services.
The Paradox of Interoperability in the Digital Era
Banking, retail, and transportation have long surpassed healthcare in digital connectivity. Consumers can move money across borders with a swipe-but struggle to transfer their own health records between hospitals in the same ZIP code. Welcome to healthcare, where your MRI and your Uber exist on different technological planets.
As organizations hoard data for competitive advantage or compliance paranoia, patients pay the price in fragmented care. Vicerion Corp’s own product suite-including Rock Paper & Scissors (a USCDI-compliant FHIR-native repository), Zero-In EMPI, Pro-Mapper, and Checkmate (our SMART on FHIR app)-demonstrates what is possible when we treat interoperability as infrastructure rather than a pipe dream.
Reasons Interoperability Remains Unstandardized
Let’s be honest. Data silos aren’t just accidents-they’re revenue streams. Many legacy vendors and EHR systems still rely on closed ecosystems to extract fees, up-charge integrations, and ensure vendor lock-in. But while closed systems benefit a few, they fail patients and burden payers.
Healthcare is the only industry where customers must beg for access to a product they paid for. That product is their medical data, buried in systems designed to resist extraction.
The Financial Impact: Death by a Thousand Interfaces
The lack of interoperability adds billions in administrative overhead. According to Brookings, up to 33 cents of every healthcare dollar is lost to back-office complexity. From 1975 to 1995, hospital beds and stays decreased, yet costs increased dramatically, driven in part by duplication and inefficiency.
Every duplicate test, every re-keyed demographic, every faxed referral is a tax on the system. More ironically, it’s a tax we pay to remain inefficient.
A Tale of Two Nations: UK vs USA Interoperability
In the United Kingdom, the NHS has made strides with the NHS App and the NHS Spine, a unified digital infrastructure enabling centralized access to patient data. UK standards are now expanding under Data Saves Lives, a national strategy integrating FHIR-based APIs, cloud-first architecture, and more standardized patient access.
By contrast, U.S. efforts under the 21st Century Cures Act and TEFCA have emphasized patient access but struggle with fragmentation. Data sharing relies on a patchwork of regional HIEs, proprietary standards, and private APIs. Progress is palpable, but interoperability often means “sort of, depending on who you ask.”
Key Differences:
● Mandates: The UK has more direct regulatory oversight through the NHS.
● Incentives: U.S. uses carrots and sticks via CMS reimbursement and ONC mandates.
● Culture: UK patients expect seamless public access; U.S. consumers often don’t even know what FHIR is.
FemTech & Equity: The New Frontier
Another often overlooked issue: most interoperability efforts fail to consider gender-based health data and disparities. FemTech startups are tackling conditions like endometriosis and hormonal disorders-but many face hurdles integrating with traditional EHRs.
Vicerion Corp is actively working with partners to ensure our Zero-In EMPI and Checkmate app support more inclusive datasets that reflect a broader spectrum of health data.
Digital equity also demands that we design systems not just for English-speaking, tech-savvy users. Interoperability that fails to address multilingualism, broadband gaps, and disability access isn’t interoperable-it’s inaccessible.
What’s Really Blocking Progress?
● Data blocking driven by competitive fear
● Limited incentives for true data liquidity
● Over-reliance on middleware instead of clean architecture
● Compliance-focused IT rather than patient-first design
Eight Strategic Recommendations for True Interoperability
1. Treat interoperability as a revenue enabler, not a cost center.
Instead of viewing interoperability as a compliance expense, forward-thinking organizations see it as an engine for patient acquisition, retention, and loyalty. Transparent access to data empowers care coordination, reduces duplicative services, and creates opportunities for new value-based care models. Health systems that enable seamless data exchange are better positioned to contract directly with employers, launch digital-first services, and scale telehealth.
2. Invest in smart, FHIR-native tooling like Rock Paper & Scissors and Zero-In EMPI.
FHIR-native platforms reduce the time, cost, and complexity of integrating systems. Vicerion’s Rock Paper & Scissors repository offers a structured, USCDI-aligned interface for all critical health data, while Zero-In EMPI ensures de-duplicated, clean identity management across sources. Stop building one-off APIs; start with reusable, standards-based frameworks.
3. Design systems around patients, not contracts.
Most systems are still engineered for billing and compliance first-patients are secondary. Flip that. A patient-first design ensures continuity of care, minimizes medical errors, and improves satisfaction. Patient-centered design doesn’t just feel better-it performs better across quality metrics and HEDIS measures.
4. Modernize your tech stack before your competitors do.
Legacy infrastructure is slow, brittle, and expensive. Cloud-first, containerized environments enable modular, scalable interoperability. Organizations with outdated databases and on-prem integration layers will struggle to meet ONC and CMS mandates, let alone respond to the next crisis. It’s not just modernization-it’s survival.
5. Support inclusive, multilingual, and accessible data capture.
Interoperability isn’t just technical-it’s human. Build intake workflows that support non-English speakers, digital novices, and persons with disabilities. Incorporate social determinants of health (SDOH), reproductive health, and gender-diverse data elements that legacy EHRs still ignore. Equity must be built into the data model, not bolted on.
6. Partner across payer, provider, and tech lines.
Interoperability isn’t a solo sport. Build alliances that allow for shared patient records, claims data, pharmacy fills, and care plans. Strategic partnerships with health tech firms, insurers, and public HIEs unlock economies of scale and reduce the time to go live. Think ecosystems, not empires.
7. Engage patients as participants in interoperability, not just beneficiaries.
Patients who can access, correct, and contribute to their records are more likely to be adherent and engaged. Offer mobile apps, digital front doors, and consent-driven data exchange. Vicerion’s Checkmate app is designed for this very purpose-to bring the patient into the clinical conversation as an active node, not a passive recipient.
8. Stop treating data like oil. Treat it like oxygen.
The “data is the new oil” analogy was always flawed. Oil is scarce and hoarded; oxygen is abundant and essential. Interoperable data should flow-cleanly, freely, and reliably. Hoarding it suffocates innovation. Liberating it fuels population health, AI models, and clinical breakthroughs.
Conclusion: From Aspiration to Execution
The road to interoperability is paved with good intentions and bad integrations. At Vicerion Corp, we believe the future lies in combining infrastructure, regulation, and design thinking to enable a healthcare ecosystem where data moves as freely as patients do.
We’re not just imagining that future-we’re building it. And ironically, it starts by letting go of control.
For demos or to explore partnerships, contact shawna@vicerion.com.
