Interoperability is the ability of different electronic health record (EHR) systems to exchange patient data and use it without someone retyping it. Federal policy has pushed for it for years, yet many practices still receive outside records by fax and file them by hand.
This guide is for practice owners, administrators and clinical leads who want to understand why exchange is still hard and what a practice can do about it. It walks through five specific challenges and a practical response to each. For the broader case for why interoperability matters, see our article on why healthcare interoperability matters.
Why is EHR interoperability still a problem?
Because exchange depends on many parties agreeing on formats, identities, rules and costs at once. A federal survey reported by the Office of the National Coordinator for Health IT (ONC), now the Assistant Secretary for Technology Policy (ASTP), found that in 2019 about a third (35%) of office-based physicians shared patient information with outside providers only by fax, mail or e-fax.
Among physicians who did exchange electronically, the most common barrier in that survey was exchanging with a different EHR vendor (85%), followed by having to use multiple systems or portals (73%) and referral partners without the capability to exchange (71%). Those figures are from 2019, but the challenges below explain why they persist.
Challenge 1: Do different systems use different standards?
Yes. Standards exist, but systems implement them in different versions and in different ways. Two EHRs can both claim support for a standard and still fail to exchange a usable record.
Health Level Seven (HL7) International publishes widely used exchange standards, including Fast Healthcare Interoperability Resources (FHIR), a standard for sharing health information between software systems. CMS interoperability rules point payers toward FHIR-based application programming interfaces (APIs), but many existing interfaces were built on other formats.
What a practice can do: ask any vendor which standards and versions it supports for each connection you need (labs, imaging, referral partners), and ask for a live example rather than a feature list.
Challenge 2: Why is patient matching so hard?
Because systems usually match records using demographic fields such as name, birth date, address and phone number. A misspelled name or an old address can split one patient into two records or merge two patients into one.
ASTP describes patient matching as identifying and linking one patient's data within and across health systems, and calls it a critical component of interoperability. The federal SAFER Guides for EHR safety include a guide dedicated to patient identification.
What a practice can do: standardize how demographics are entered at intake, verify identity at every visit, and have a clear process for reviewing possible duplicates. Our article on duplicate medical records in electronic medical records (EMRs) covers the clean-up side.
Challenge 3: What role do policy and information blocking play?
Federal policy now treats sharing as the expected norm, but the rules are detailed and still evolving. The 21st Century Cures Act, enacted in 2016, prohibits information blocking: practices by certain actors that are likely to interfere with access, exchange or use of electronic health information, unless required by law or covered by an exception.
The actors named in the rule are health care providers, developers of certified health IT, and health information exchanges and networks. The exceptions are listed in 45 CFR Part 171, and HHS has finalized disincentives for providers found to have committed information blocking.
On the payer side, the Centers for Medicare & Medicaid Services (CMS) Interoperability and Patient Access Final Rule (CMS-9115-F), published in 2020, requires certain payers to offer APIs for patient access and data exchange. The later CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) set additional payer provisions from January 1, 2026, with most API requirements due by January 1, 2027. At the national level, the Trusted Exchange Framework and Common Agreement (TEFCA) is designed to connect health information networks so records can follow the patient.
What a practice can do: make sure your release-of-information process answers requests promptly and consistently, and ask your compliance adviser how the information blocking rules apply to your practice.
Challenge 4: How much does interoperability cost?
More than many practices expect. Interfaces to labs, imaging centers and other systems can carry setup and ongoing fees, and every connection needs someone to monitor it. In the 2019 ONC survey, 55% of physicians who exchanged electronically cited additional costs as a barrier, and 37% cited limited or no IT staff.
What a practice can do: prioritize the connections that remove the most manual work, usually labs and your highest-volume referral sources, and ask vendors to put interface fees and maintenance responsibilities in writing before you sign.
