An electronic health record (EHR) holds a patient's history, medicines, test results and notes. Most hospitals in rich countries now use one. But records are only useful if they can follow the patient. Interoperability means different systems can share and use each other's data.
Four parts of interoperability
The US Office of the National Coordinator for Health IT (ONC) measures four parts [1]:
- Send: sending records to another provider.
- Receive: getting records from outside.
- Find: searching for a patient's records held elsewhere.
- Integrate: adding outside data into the hospital's own record without retyping.
Progress in US hospitals
In 2023, 70% of non-federal acute care hospitals did all four at least sometimes [1]. That compares with 23% in 2014 and 46% in 2018 [2]. ONC's latest quick-stats report that this reached 76% by 2025 [3].
"Sometimes" is not enough. ONC itself has pointed out that routine, everyday exchange is the real goal [2].
Why it still matters
- Safety: doctors need to know allergies and medicines from other providers.
- Less waste: fewer repeated tests and scans.
- Continuity: smooth handovers from hospital to home or clinic.
- Patients: easier access to their own records.
- Research and public health: better data for tracking disease.
Barriers
- Different systems and data formats.
- Data that arrive but are hard to use or trust.
- Cost and staff time for smaller hospitals and clinics.
- Privacy and consent rules.
- Business reasons to keep data inside one network.
Security risks grow with sharing
More connected systems mean more ways in for attackers. HHS reported that hacking made up 79% of large health data breaches in 2023, and those breaches affected over 134 million people [4]. Interoperability must be built with strong security from the start.
Beyond the US
Many countries are building national digital health systems, unique health IDs and shared standards. Common standards, such as HL7 FHIR, make it easier for systems to talk. Countries starting now can design for sharing from day one.
Key numbers at a glance
- 70% of US hospitals did all four steps in 2023.
- 76% in 2025.
- Only 23% in 2014.
- Large breaches in 2023 affected over 134 million people.
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Routine use is rising
ONC reports that from 2018 to 2023, the share of hospitals that routinely engage in interoperable exchange rose by 54% [5]. Routine use matters because "sometimes" may mean only some patients, some partners or some types of data.
Why integration is the hardest step
Many hospitals can receive records, but fewer can easily pull outside data into their own system. Doctors may need to open a separate file or read a long PDF. If outside data are hard to find, they may be ignored. Tools that turn outside records into structured, searchable data make them much more useful.
Patients and their records
Patient portals and apps let people view test results, visit notes and medicines. When records are shared, patients can carry their history when they move or see new doctors. Clear rules on who can see what, and the ability to correct errors, help build trust.
Smaller providers
ONC has noted that challenges remain for physicians, compared with hospitals [2]. Small clinics, rural hospitals and long-term care homes often have older systems and fewer IT staff. Without them, gaps in records remain, especially for older patients who move between care settings.
Standards that help systems talk
Common standards make sharing easier. HL7 FHIR lets systems exchange data in small, structured pieces through modern web interfaces. Standard codes for diagnoses, tests and medicines mean a result means the same thing everywhere. National networks link hospitals so they can find records held elsewhere.
Questions for hospitals
- Can we find records from other providers in a few clicks?
- Do outside results appear in the same place as our own?
- Can patients see and share their own records easily?
- Are we connected to the networks our partners use?
- How do we protect shared data from attack?
Answering yes to all five is what routine interoperability looks like in practice.
Interoperability and AI
AI tools need complete, well-organised data to work well. When records are scattered across systems, AI sees only part of the picture. Better interoperability makes it easier to build and safely use AI for tasks such as spotting patients at risk or summarising long histories. It also makes it easier to check whether AI tools work equally well for all groups of patients.
What this means
EHRs are now standard in many hospitals, but the job is not done until records follow patients everywhere. The next steps are routine exchange, easy use of outside data, inclusion of small providers and strong security.
Where to read more
All figures in this article come from public sources listed below. For more detail, start with ONC's data briefs and quick-stats on hospital interoperability. Each is free to read online. Hospital and clinic leaders can use these sources to compare their own progress with national figures and to set clear goals for the next year. If anything here raises a question about your own health, take this article to your doctor or pharmacist and talk it through together.
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Topics: Health IT and data · Digital health · Hospital
Sources
- ONC data brief: Interoperable exchange of patient health information among US hospitals, 2023
- ONC: US hospitals make strides in interoperability
- ONC Health IT Quick-Stats: Electronic health information exchange by hospitals
- HHS Office for Civil Rights (Mar 2024): statement on large breaches and ransomware
- ONC: 70% of hospitals participate in healthcare interoperability
Banner image: Doctor reviews patient information on tablet in an office setting by Shixart1985, CC BY 2.0, via Wikimedia Commons.
The data behind this story
Topics: Health IT and data · Digital health · Hospital
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