2026 executive update · hospital interoperability 2023 · Leadership action
Interoperable Exchange of Patient Health Information Among U.S. Hospitals in 2023
The 2023 hospital interoperability results showed broad progress and a more important execution gap. According to the federal data brief, 70 percent of non federal acute care hospitals at least…
At a Glance
Those figures should change how executives define success. Connectivity is necessary, but a network connection, interface, or inbound document does not prove that useful information reaches the right person in time to influence care. The gap between availability and routine use is a governance problem involving…
Executive perspective
The 2023 hospital interoperability results showed broad progress and a more important execution gap. According to the federal data brief, 70 percent of non-federal acute care hospitals at least sometimes performed all four measured exchange domains: send, receive, find, and integrate. Yet only 43 percent did so routinely. Seventy-one percent reported routine electronic access to necessary outside clinical information at the point of care, while only 42 percent said clinicians routinely used that information when treating patients.
Those figures should change how executives define success. Connectivity is necessary, but a network connection, interface, or inbound document does not prove that useful information reaches the right person in time to influence care. The gap between availability and routine use is a governance problem involving data quality, patient matching, workflow, trust, usability, policy, and accountability.
The benchmark also showed uneven participation. Smaller, rural, critical access, and independent hospitals reported less routine interoperability than better-resourced peers. Exchange with long-term and post-acute care and behavioral health providers was much less extensive than exchange with hospitals and ambulatory providers. An enterprise strategy should therefore measure practical use across the full care continuum, not celebrate an aggregate connection rate that conceals weak transitions.
Leadership priorities
Build an integrated leadership response
Establish an Interoperability Baseline Leaders Can Trust
Use the federal four-domain model as a starting point, then define each measure operationally. Sending may mean a document left the organization; receiving means it arrived; finding means outside information can be located; integrating means data enter the EHR without manual transcription. Routine use adds another standard: clinicians can find, understand, reconcile, and act on information during real care.
Build a baseline by high-value transition, including emergency arrival, hospital admission, specialist referral, discharge, post-acute transfer, behavioral health coordination, and payer interaction. Segment results by facility, service line, partner type, time of day, patient population, and exchange method. Separate successful transactions from clinically complete exchanges.
Reconcile vendor logs, network reports, EHR audit data, chart review, help-desk records, and frontline observation. No single source proves interoperability. Assign definitions, owners, calculation logic, limitations, and refresh cadence in a metric catalog. Executives should be able to trace a dashboard number to the workflow and source data that produced it.
Design Exchange Around Clinical Decisions
Choose a small set of decisions where outside information can prevent harm or delay, such as medication reconciliation, duplicate imaging, allergy review, prior results, follow-up, and post-discharge care. Map what information is needed, when it is needed, who reviews it, how discrepancies are resolved, and what action should be documented.
Reduce the cognitive cost of using exchanged data. Long documents, duplicate entries, inconsistent terminology, buried dates, and poorly labeled external sources make technically available information impractical. Configure summaries, filters, notifications, reconciliation queues, and provenance displays with clinicians. Measure clicks and review time alongside completeness and outcome.
Test the workflow under representative conditions, including emergency care, nights, weekends, downtime, unmatched patients, consent restrictions, and incomplete records. Give teams an escalation path when an outside record is missing or contradictory. The aim is not to make every data element equally visible; it is to make trusted, relevant information usable at the decision without obscuring local clinical judgment.
Include the patient as both a user and a source of correction. Test whether people can obtain, download, transmit, and understand their information, identify an error, and learn what happened after requesting a correction. Measure identity-proofing failure, portal access, language support, proxy access, and response time. A technically successful exchange can still exclude the person whose care and choices the information is meant to support.
Govern Identity, Meaning, Quality, and Provenance
Create enterprise data owners for the high-value elements exchanged across transitions. Standard definitions and vocabularies support interoperability, but local governance must address mapping, units, status, timestamps, corrections, duplicates, and source context. Track conformance to the required standard and the clinical meaning preserved after transformation.
Strengthen patient matching with standardized registration, demographic-quality monitoring, duplicate prevention, merge controls, and transparent exception handling. Measure false matches and missed matches, not only automated match rate. Include privacy, safety, health-information management, and frontline representatives in policy because a matching decision can expose information or withhold it from care.
Preserve provenance so users can see where information originated, when it was recorded, whether it was amended, and how it entered the local record. Data quality should be evaluated by intended use. A field sufficient for a directory may not be adequate for a clinical decision, quality measure, or automated model. Make corrections traceable and communicate material changes to downstream recipients where supported.
Govern reuse as carefully as initial exchange. Data sent for treatment may later enter analytics, quality reporting, research, or artificial intelligence workflows with different quality and authorization needs. Catalog those downstream uses, retention, transformation, and access. Require validation before repurposing data and monitor whether missingness or partner variation creates biased conclusions. Interoperability increases the value of data, but it also expands the consequences of weak definitions.
Close the Continuum and Resource Gaps
Prioritize partners where the benchmark showed weaker exchange, especially long-term and post-acute care and behavioral health. Conduct joint workflow reviews rather than imposing a hospital interface specification. Identify the minimum information each partner can send, receive, and use, plus consent, technical, staffing, and financing barriers. Offer phased options that do not require an enterprise EHR.
Use regional exchange, national networks, direct connections, portals, and APIs according to the use case. TEFCA can support network-to-network exchange through a common framework, but participation still requires local decisions about endpoints, identity, permitted purposes, workflows, and support. Avoid overlapping connections that generate duplicate documents without improving coverage.
Include resource equity in the business case. A small partner may create high transition value but lack interface staff or capital. Shared implementation support, standard onboarding, testing tools, and transparent fees can improve network performance for everyone. Track whether information crosses organizational boundaries and whether the receiving setting can act on it, not only whether the hospital completed its part.
Align Compliance, Value, and Portfolio Governance
Create one governance forum for interoperability investments, information-blocking risk, standards adoption, payer APIs, network participation, privacy, cybersecurity, and clinical value. Legal interpretation should inform operations, while technical capability should not dictate policy alone. Document how practices affecting access, exchange, or use are reviewed and how applicable exceptions or legal requirements are assessed.
Rank investments by patient and enterprise value. Strong candidates reduce repeat testing, incomplete referrals, medication discrepancies, manual retrieval, delayed authorization, avoidable utilization, or patient effort. Define baseline cost and outcome measures before implementation. Include the burden of interfaces, subscriptions, data reconciliation, support, and workflow change.
Use a quarterly portfolio review to expand, redesign, retire, or consolidate connections. Require evidence of coverage, reliability, quality, use, and outcome. Network breadth without adoption can create expense and noise, while a narrow workflow that reliably changes care may deserve expansion. The board should see interoperability as a clinical operating capability with regulatory and strategic consequences, not as an IT project list.
Make vendors accountable for operational performance, not only interface availability. Contracts and service reviews should cover transaction completion, latency, data loss, mapping defects, duplicate content, change notification, testing, incident cooperation, and access to usable logs. Establish who resolves failures that cross EHR, network, and partner boundaries. Require implementation documentation and data portability so the organization can change suppliers without losing definitions or history. Technical service levels should be paired with clinical indicators because a fast exchange of incomplete or unusable information is still a failed transition.
Leadership cadence
Start, strengthen, and measure the system in 90 days.
Phase 1, days 1 to 30
Establish executive and clinical ownership, adopt metric definitions, and baseline three transitions using logs, audit data, chart review, and observation. Compare technical success with information completeness and routine clinical use. Identify one weak partner segment and the largest source of matching or reconciliation failure.
Phase 2, days 31 to 60
Redesign one decision-centered workflow, assign data owners, and correct the highest-impact identity, mapping, provenance, or usability defect. Engage a long-term care or behavioral health partner to define a minimum viable exchange. Document compliance, consent, security, and support requirements.
Phase 3, days 61 to 90
Pilot across representative shifts and sites, measure availability, use, action, and balancing burden, and resolve failures weekly. Present leaders with scale or stop criteria, partner-support needs, standards and API dependencies, total cost, regulatory exposure, and a 12-month portfolio roadmap.
Decision-grade measurement
Decision-Grade Metrics
- Send, receive, find, and integrate success by transition, site, partner type, and exchange method
- Outside information available, opened, reconciled, and used at the intended clinical decision
- Completeness, timeliness, conformance, mapping error, duplication, and provenance visibility
- Patient match rate, false matches, missed matches, duplicate records, and correction time
- Exchange coverage with hospitals, ambulatory, post-acute, behavioral health, laboratories, and payers
- Clinician review time, clicks, reconciliation backlog, help requests, and alert burden
- Repeat testing, medication discrepancies, referral completion, readmissions, and patient effort
- Connection and support cost, avoided manual work, portfolio consolidation, and compliance findings
SEO
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Conclusion
Turn strategy into an accountable operating system.
The 2023 benchmark documented real progress, but its most actionable finding was the distance between exchange capability and routine use. Health systems cannot close that gap with connectivity alone. They need trusted definitions, decision-centered workflows, governed data, inclusive partner strategy, and evidence of clinical action.
The executive standard should be simple: information reaches the right setting, can be matched and understood, changes an appropriate decision, and improves care without creating disproportionate burden. When leaders measure that chain directly, interoperability becomes a source of safer transitions and strategic value rather than a technical claim.
Executive questions
Frequently Asked Questions
1. What did “interoperable” mean in the 2023 federal hospital data brief?
The measure assessed whether hospitals electronically sent, received, found, and integrated patient health information from outside their organization. The brief distinguished hospitals doing all four routinely from those doing them sometimes and from those not fully engaged.
2. Why is access to outside information different from routine use?
Information may be available but difficult to locate, trust, interpret, or reconcile during care. Routine use depends on workflow, relevance, presentation, patient matching, provenance, training, and clear responsibility for acting on discrepancies.
3. Should a health system connect to every available network?
Not automatically. Evaluate population and partner coverage, exchange purposes, reliability, duplication, workflow fit, cost, security, and support. Consolidate redundant connections when they add noise without improving access or continuity.
4. How should leaders address weaker exchange with behavioral health and post-acute care?
Co-design a minimum useful data set and workflow with those partners, including consent and privacy requirements. Offer phased technical options and shared onboarding support, then measure whether the receiving team can use information at the transition.
5. What is the best board-level interoperability measure?
Use a small balanced set: coverage of high-risk transitions, information available and used at the decision, data and matching quality, partner gaps, patient or clinician burden, outcome improvement, regulatory exposure, and total operating cost.
