Why interoperability is shifting from a tech problem to a money problem

The healthcare industry has made real headway connecting electronic health records over the past several years, but a survey suggests the next phase of the fight won't be won with better software — it'll be won with budget and buy-in. As Medical Economics has previously reported, even in 2026 it can be easier for a physician to fax a record than to send it electronically, despite years of policy mandates aimed at fixing exactly that. Further research is finding that hospital CIOs increasingly point to cost and vendor unwillingness — not technical limitations — as the primary barrier to true data exchange. That shift matters for physicians on the front lines, who are still often forced to make clinical decisions with an incomplete chart. The conversation is also colliding with health systems' growing interest in AI, where siloed data threatens to undercut the technology's promise before it even gets off the ground. Medical Economics spoke with Sandra Johnson, senior vice president of CliniComp, about what it will take to get full interoperability.

Medical Economics: When you look at interoperability today, how would you characterize the gap between where we are and where we need to be?

Sandra Johnson: The gap has shifted. We used to think of it as a technical gap — something that would be solved with the right technology and standards. But in a recent survey we conducted with CHIME, CIOs told us that what's actually blocking them now comes down to cost and unwillingness. Forty-seven percent said cost is their top barrier. So it's really a business model problem now, not an engineering one.

Medical Economics: When you say cost, where is that cost coming from, and who's responsible for paying it?

Johnson: A lot of data is still siloed across many systems, so the cost isn't just financial — it has a clinical impact, too. When you only have 40% of the information you need and the rest is stuck in siloed systems, you're treating the patient with half the chart. That's a human cost, not just a financial one. We don't want clinicians making decisions with only half the information, so it comes down to bridging the gap between siloed systems and having the underlying architecture to support and normalize data across them.

Medical Economics: Interoperability used to rank very high on our physician surveys as one of the top problems in health care, and it's been steadily falling down the list. What do you attribute that progress to?

Johnson: We've had some vendor consolidation, and there have been policies and government incentives that helped drive interoperability forward. That's helped us connect systems and build more integration and interfaces. But the next level is making sure that data is usable — if you have the data but it's not fully connected and presented at the point of care, that's still a challenge for improving patient care. We've made great strides on integration and connection points, but we still need to make sure that data is usable at the point of care.

Medical Economics: What needs to happen to bridge this remaining gap and get physicians data in a usable format?

Johnson: We need to stop treating interoperability as a one-off project. We need to treat it as a foundational model. When we bolt on technology or tools to solve it, we're not actually building interoperability — we have to look at the core infrastructure and make sure we have a foundation that can scale. Working with health systems to implement scalable architecture that supports their needs and grows with them over time is important.

Medical Economics: Is data blocking still a problem? Is anything being done to solve it?

Johnson: Our survey pointed to vendor unwillingness and delays as a barrier when it comes to data blocking. Regardless, it's really a market failure, and we all need to work together to fix it — shifting to a partnership model where everyone owns their part of the ecosystem and helps bridge those pieces to get to an interoperable solution.

Medical Economics: Patient identity matching is often cited as a problem in health care. Does that contribute to interoperability issues?

Johnson: It definitely can. It comes back to having underlying architecture that can normalize data so you can ensure a holistic view of the patient at the point of care. Clinical frustration is growing when you don't have access to all the data you need when you need it. Having underlying architecture that can mitigate those challenges sets us up for success long term.

Medical Economics: Where does AI fit into the interoperability issue?

Johnson: It's a hot topic in the industry — 100% of the CIOs we surveyed said that AI running on interoperable systems is important to their organization. This isn't just a preference anymore. Having siloed data means your AI is working on partial information, and we don't want to leverage AI on siloed data sets, because then you're not getting the holistic view of the patient. That same logic applies to AI-driven care — we have to solve the interoperability challenge to make sure AI delivers the value we expect from it.

Medical Economics: Payers, providers, vendors and regulators all have to work together for interoperability to work. Is any one of those stakeholders the biggest bottleneck right now?

Johnson: I don't think one individual or entity is the bottleneck. In our survey, CIOs told us they're looking for industry consortiums — making sure EHR vendors are working with health systems and taking on co-ownership of the problem. That's what will help us make an impact and see results. We're shifting away from blaming a single individual or entity and moving toward a genuine appreciation for collaboration to make sure that we make strides in this area.

Medical Economics: Looking ahead five years, what does interoperability look like?

Johnson: It's having a truly connected and holistic view of the patient at the point of care. So much of clinicians' frustration comes from technology being a barrier instead of an enabler. Getting to a point where systems and platforms can serve up data in meaningful ways at the point of care — that's what success looks like. We want to improve patient care and outcomes by bridging all the information that exists on an individual at the point of care. That's the game changer, and I'm excited to be part of solving those challenges.

Medical Economics: Is there anything else physicians should know about interoperability, whether where we are today or where we're heading?

Johnson: From a provider's perspective, there's a lot of fragmented data out there, and it's slowing down clinical decision-making. Partnering with IT teams to understand the pain points and challenges physicians are facing lets us come up with scalable solutions that improve how they deliver care day to day. We want all key stakeholders engaged and involved so we're solving the real challenges.