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Interoperability: A goal across the Healthcare industry for decades, what are the challenges facing interoperability and what can Federal agencies do?

By George Hou, Head of Solutions for the Department of Veterans Affairs, InterSystems

Five quintillion bytes of data are produced every day. The public and private sectors have vast quantities of data at their fingertips, but the full power of that data has yet to be realized. In the Healthcare industry, access to data isn’t enough. Data must be collected, cleaned, aggregated and normalized to equip Healthcare providers with a full understanding of a patient’s health history to make actionable and informed care decisions. At the Federal level, Healthcare interoperability would enable key Federal agencies, such as the Department of Veterans Affairs (VA), the Department of Defense (DOD), the Federal Emergency Management Agency (FEMA), and Health & Human Services (HHS) including the Centers for Disease Control and Prevention (CDC) as well as the National Institutes of Health (NIH), to seamlessly communicate and more effectively deliver assistance to large groups of vulnerable individuals. Why then is interoperability a challenge?

The Urgency Driving a Decade-Long Goal

While true interoperability has been a goal of the U.S. Healthcare industry since the implementation of the HITECH (Health Information Technology for Economic and Clinical Health) Act in 2009, more than a decade has passed and Healthcare interoperability has yet to be fully realized. However, recent steps have been made at the Federal level to improve interoperability nationwide, including the implementation of the first requirements of the Centers for Medicare and Medicaid Services (CMS) Interoperability and Patient Access final rule (9115-F), which went into effect January 2021. This new set of Federal guidelines grants patients increased access to their health information, improves interoperability, and reduces the burden on payers and providers.

In addition to recent regulatory strides, the COVID-19 pandemic created a sense of urgency and magnified the importance of Federal interoperability. Access to crucial Healthcare data related to testing and COVID-19 cases directly informs the Federal Government’s policies and allocation of resources and supplies across the country. With distribution of the COVID-19 vaccine well underway, interoperability is essential in allocating vaccine doses to Federal agencies, including VA. With 37% of the current U.S. Veteran population 65 years or older, VA needed to quickly mobilize to ensure its patient population received priority access to the COVID-19 vaccine. To qualify for priority access, VA needed to provide the CDC with data detailing its handling of the pandemic, including total number of past and present COVID-19 cases among patients and staff — a significant undertaking given VA’s 172 medical centers and 1,074 outpatient clinics –  while also ensuring to CDC that VA had the ability to report vaccines administered to Veterans and separately, employees.

Within weeks, VA automated IT processes across its 130 electronic medical record systems and identified nearly 130,000 Veterans and employees within VA’s network who tested positive for COVID-19. Integration and interoperability across VA’s systems including Spokane, the first VA medical center migrated to Cerner Millennium, made that reporting possible and met the CDC requirements for VA to be included in the first wave of the vaccine distribution.

The Challenges of Obtaining Interoperability

While interoperability is both critical and possible, there are challenges that hinder its widespread adoption:


In part, the lack of interoperability can be attributed to the rise in consolidation within the Healthcare industry, which has ripple effects for private Healthcare companies as well as Federal agencies. As Healthcare organizations merge and data from multiple electronic health records (EHRs) is consolidated, organizations need a full view of patient records to inform patient care, research, personnel, logistics, and supply chain management decisions. On average, an integrated health system works with 16 distinct EHR platforms. Consolidation can lead to a scattering of critical patient information across the Healthcare network, making it difficult for interoperability to be achieved.


Lack of communication is both a cause and an effect of insufficient interoperability. On one hand, a lack of consistent communication between public health systems and other Federal agencies impedes efforts to achieve interoperability nationwide. On the other hand, without interoperability in the first place, information cannot be shared effectively across the local, state and Federal levels, hampering efforts to implement a unified strategy for combating COVID-19.

How Interoperability Can Be Achieved at the Federal Level

Federal agencies, like VA and CDC, play an important role in the collective effort to achieve interoperability. They set a standard and expectations for the rest of the country. Without true interoperability at the Federal level, the exchange of Healthcare information between the Federal Government and local and state health officials is disjointed.

Throughout my career, I have learned a series of key lessons to obtain interoperability that can be applied to organizations not just at the Federal level, but in the private sector as well.

Take an unbiased approach

Healthcare organizations that want to expand interoperability, should assess their existing data exchange capabilities and proceed with a balanced approach. It can be especially difficult for Federal agencies to embrace new technology when existing legacy systems are entrenched and have existed for decades. Decision makers should keep an open mind to new technologies that could be combined with legacy systems or replace old technology. However, it is important not to fall victim to ‘shiny objects’ that may detract from an organization’s initial goals.

Be Agile

To avoid outgrowing and replacing systems every few years, Healthcare organizations should select an interoperability platform that can be modified as needed to achieve the original goal of deployment and adapt to solve future issues – true extensibility. Ensure that the organization’s overall data environment adheres to industry standards. This gives organizations the ability to simply ‘plug and play’ when introducing new technology in a structured way.


To obtain interoperability, communication across Federal agencies is crucial. The early distribution of the COVID-19 vaccine to Federal agencies is one such example of cross-agency collaboration that would not have been possible without frequent open communication. Beyond the COVID-19 pandemic, Federal agencies must continue to communicate with one another to share critical Healthcare information and expand interoperability.

Our nation is stronger and better equipped to take on public health crises of this magnitude when we pool our resources and expertise. The same holds true for interoperability. When data is consolidated, cleaned, and normalized, it enables providers to gather actionable insights that can be shared and leveraged by various agencies to better serve patients no matter where they are. While interoperability is crucial at every level of the Healthcare industry, it is especially important at the Federal level because of the repercussions that Federal policy has on the patient population as a whole. By taking a look at where the challenges reside, Federal agencies will be better suited to expand interoperability, inspiring other Healthcare organizations to follow suit.

About George Hou

As Head of Solutions for the Department of Veterans Affairs at InterSystems, George Hou is responsible for leading InterSystems relationship with VA as national account manager. In his role, George is focused on providing VA clinicians with the technology they require to deliver the best care possible for our nation’s veterans and their families, setting a standard for the rest of the country on the value of access to critical healthcare data.

About InterSystems

InterSystems empowers organizations to best apply the healthy data required to power the world’s most important applications. A strategic technology provider for more than 40 years, InterSystems provides healthcare, business, government, finance, and other sectors with unified, clean, and actionable data for driving better outcomes.



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