Why Interoperability Is Healthcare’s New Competitive Edge

Over the past decades, interoperability in healthcare has largely been driven by compliance requirements. To improve the exchange of health information, most organisations invested in APIs, FHIR (Fast Healthcare Interoperability Resources), patient access initiatives and other regulatory mandates. These were necessary investments, but as the focus shifts from whether healthcare organizations can exchange data to whether they can use connected data to generate measurable business and patient outcomes, interoperability in a strategic form has become a key topic of discussion. This progress also reveals the next challenge.  

According to a 2026 ONC analysis of American Hospital Association survey data, 96% of US hospitals can electronically send patient information and 94% can find it, but only 79% can integrate that information into their EHRs. Healthcare has made significant progress on moving data. The next challenge is making that data usable within the workflows where decisions are made. 

From Data Exchange to Actionable Value 

That shift is already changing how the industry thinks about interoperability. Gartner describes the health information exchange market as moving from commoditized data transport toward high-value data activation. The implication is important: interoperability is increasingly valuable not simply because information can move between systems, but because connected data can be put to work across clinical and operational workflows. Interoperability is now being assessed more in terms of its outcomes than based on the quantity of information exchanged.  

Connected data is enabling real time prior authorisation, smoother provider workflows, value-based care, simpler onboarding and more seamless patient experiences. When there is a benefit for all parties involved, organisations are much more likely to participate in data sharing. Although regulation may mandate the sharing of information, demonstrating the value in practice drives organizations to better use the data. As interoperability matures, the ability to create value from data matters more than compliance alone. 

Ecosystem Alignment Is Becoming the Bigger Challenge 

With the addition of the Trusted Exchange Framework and Common Agreement (TEFCA) and advances in FHIR standards, many of the obstacles are beginning to shift beyond pure technology toward incentives, governance and stakeholder alignment. While the various elements of the healthcare ecosystem (providers, payers, technology companies and regulators) may all coexist in a single environment, there is not necessarily an equitable value exchange across all ecosystem elements when data is shared. In some cases, data is still viewed as a competitive advantage and not as a valued, shared resource. Regulation further complicates the ecosystem.   

National organisations must work within a patchwork of state privacy laws, consent rules and protections around sensitive health information. Behavioural health records make this harder still. Managing consent in a way that protects privacy, meets compliance requirements and still allows data to be shared efficiently remains a challenge. 

Interoperability as Infrastructure 

For years, interoperability was funded like a project: a fixed requirement, a fixed budget, a fixed deadline. That mindset caps its value. The same capability that satisfies a compliance mandate can also power prior authorisation, provider onboarding, identity matching, longitudinal records, value-based care and the workflows coming next. Building it once and reusing it is the whole point. 

Most organisations aren’t tearing out legacy systems to get there. They’re leaving them in place and building around them, exposing the data through APIs and layering modern integration on top. It’s the safer path, and it’s also the one that lets a single investment pay off across several projects instead of one. That’s the harder sell to a finance team. 

Infrastructure rarely shows a return on the timeline a single project budget expects, so it needs someone senior enough to back it before the payoff is visible. 

AI Can Help, but It Cannot Solve Everything 

AI is adding another dimension to this evolution. Gartner has identified agentic AI data sharing as an emerging consideration in interoperability strategy for US healthcare payers. AI can reduce development effort, transform data between formats and help organizations work with information across distributed systems. But it does not remove the need for sound data architecture, governance, consent and incentives. 

AI is also beginning to accelerate interoperability efforts. It can reduce development work, transform data between different formats, extract insights from unstructured information and support greater automation. AI technologies will not eliminate the foundations that support successful interoperability. AI bridges may reduce the complexity of interacting with a set of distributed systems; however, they cannot resolve complexities in systems relating to governance, control, investments and incentives. 

Therefore, AI has a positive role in engineering interoperability as a complement to existing systems rather than substituting for weaknesses in the infrastructure. 

What Comes Next 

Longitudinal patient records, pieced together from providers, health plans, pharmacies, labs and every other care setting a patient touches, are where interoperability is headed next. It’s a genuinely useful idea: a fuller picture of someone’s healthcare journey instead of scattered fragments. But getting there raises questions like who owns the record, whose version counts when two do not match, and how consent holds up once data starts moving between systems for purposes beyond those for which it was originally collected. Some of this is already on the clock. 

Payers had to meet the operational side of CMS’s prior authorisation rule, faster turnaround times, clearer denials, by January this year. The harder part, four live FHIR APIs, is due January 2027. CMS estimates getting this right saves the system roughly 15 billion dollars over a decade, which is the kind of number that gets a CFO’s attention in a way “compliance deadline” never does. 

Technology alone does not solve the problem. Everyone must work together – payers, providers, vendors – and all must move in the direction. Trustworthy governance and steady funding are also needed. Healthcare is slowly shifting from sharing data because it is required to sharing data because it is desired. That shift will decide whether better data leads to care, simpler systems and better outcomes, for patients or whether it remains just an unfinished piece of infrastructure.