How To Improve EHR Interoperability: Practical Steps for Seamless Data Exchange

Most leaders who open this guide already feel the weight of scattered systems, missing data, and integrations that drag on for months. You’re likely looking for practical, reliable ways to improve EHR interoperability in healthcare without ripping out the systems your teams depend on.

This frustration shows up at predictable moments: while connecting a new app, onboarding a partner, expanding to new sites, or preparing for value-based care.

TechMagic sees this often when we help hospitals modernize legacy integrations or add FHIR-based layers to older electronic health records (EHRs). The data exists, but it doesn’t move cleanly or consistently.

In this guide, you’ll get clear, actionable strategies on how to improve EHR interoperability in medical organizations, understand which standards matter most in 2026, and learn what actually works in real environments. By the end, you’ll know how to upgrade your architecture, governance, and workflows to facilitate seamless data sharing.

Let’s start with what EHR interoperability really means today.

Key Takeaways

• EHR interoperability fails most often because data is fragmented across outdated architectures, inconsistent standards, and mismatched workflows.
• FHIR and API-first design are now the fastest, most scalable ways of how to improve EHR interoperability in healthcare, but real-world success still depends on consistent implementation across vendors.
• Legacy messaging formats like HL7 v2 and documentation standards like C-CDA remain deeply embedded in hospital operations, which means modern healthcare interoperability requires hybrid architectures, not sudden replacement.
• High-quality data matters as much as modern APIs. Without clean terminology, complete records, and structured documentation, even the best integrations deliver limited clinical value.
• Governance is a critical missing piece. Shared rules for mapping, workflows, and terminology reduce medical errors and help teams avoid costly interface rework.
• Identity matching through MPI tools is foundational. Poor patient identity management quietly creates some of the biggest safety and coordination problems.
• Cloud-native infrastructure accelerates data exchange as it simplifies scalability, monitoring, and analytics across distributed systems.
• Data security and compliance (HIPAA, GDPR, ONC, local policies) must be built into the architecture from day one to avoid integration delays later.
• You don’t need a new EHR to improve EHR interoperability in medical organizations. Extending legacy systems with a modern interoperability layer is often the most realistic and cost-efficient path.
• TechMagic supports this journey: we build HIPAA-compliant EHR solutions, develop custom FHIR APIs, modernize legacy stacks, and deliver cost-effective Medplum-based platforms for faster interoperability adoption.

What Is EHR Interoperability and Why Does It Matter?

EHR interoperability means that clinical systems can exchange data in a consistent, usable format so providers can access complete patient information when they need it.

EHR interoperability matters because care breaks down the moment data becomes fragmented: missed labs, incomplete histories, and duplicated work all stem from systems unable to exchange information.

Now let’s look at the less obvious parts that shape how healthcare interoperability works in practice.

Even though most leaders understand the basics, the definitions still differ between regions. In the U.S., EHR interoperability is tightly linked to regulatory frameworks like USCDI, TEFCA, and certification rules. Europe takes a broader, cross-border approach, especially with the emerging European Health Data Space (EHDS). Both aim for seamless communication and exchange, but the US focuses on exact data classes, while Europe prioritizes cross-country portability and patient empowerment. This gap often complicates integrations for global organizations.

There’s also a financial weight behind the concept. Poor interoperability increases administrative time, slows reimbursement, and forces organizations to maintain multiple custom interfaces. In fact, nearly one-quarter of U.S. health-care spending is considered wasteful, amounting to approximately $1 trillion annually. This underlines the huge cost of inefficiency and fragmentation in the system. We see this often at TechMagic when helping clients replace outdated point-to-point connections with API-driven architectures that reduce long-term integration costs.

In short, EHR interoperability ≠ just moving data. It’s ensuring the information is complete, structured, and trustworthy regardless of where it originates. And that reliability is what every subsequent strategy in this guide aims to strengthen.

EHR Interoperability Statistics: Key Facts

Before discovering why improving EHR interoperability is still challenging in 2026, let’s see a few relevant facts. Numbers always speak louder than words.

Patient access and FHIR APIs

• As of 2024, almost all U.S. hospitals implemented core patient engagement features mandated by federal programs. 99% of hospitals allow patients to electronically view their medical records, 96% allow patients to download their data, and 84% enable patients to transmit records and share with a third party (ONC/ASTP).
• 95% of hospitals offer patients access to their clinical notes (an outcome of the Cures Act “Open Notes” rule), and 92% support secure messaging between patients and providers (ONC/ASTP).
• Hospitals are increasingly letting patients access data through API-powered apps (using standards like HL7 FHIR). In inpatient settings, the share of hospitals enabling patients to connect third-party applications to their EHR data rose from 68% in 2021 to 83% in 2024 (ONC/ASTP).
• Yet more advanced engagement is still emerging. In 2024, only 45% of hospitals allowed patients to import their own health records or submit patient-generated health data (PGHD) via apps into the EHR. This indicates that while read-access via FHIR APIs is now common, write-back of patient data and device data into provider EHRs remains limited (ONC/ASTP).

U.S. hospital EHR interoperability progress

• In 2023, 70% of U.S. non-federal acute care hospitals reported engaging in all four domains of interoperable exchange (electronic sending, receiving, finding, and integrating of patient information) at least “sometimes.” However, less than half (43%) routinely achieve interoperability fully (ONC).
• About 71% of hospitals said they can routinely access necessary clinical information from outside providers, but only 42% indicated that their clinicians actually use that external information routinely at the point of care. In other words, having data available doesn’t always translate to it being utilized in clinical decisions (ONC).
• Interoperability beyond traditional healthcare providers remains limited. Only 16% of hospitals reported they send summary-of-care records to most or all of their long-term care or post-acute facilities, and just 17% send summaries to the majority of behavioral health providers (ONC).
• Lower-resourced hospitals lag significantly in EHR interoperability. Just 22% of independent hospitals (not part of a system) routinely exchanged data across all domains, versus 53% of system-affiliated hospitals (ONC).
• 55% of independents were not fully interoperable even on a “sometimes” basis, compared to only 18% of hospitals in multi-hospital systems (ONC).
• Small, rural, and critical-access hospitals similarly trailed larger urban facilities. For example, about 41% of rural/CAH hospitals had no full interoperable exchange, nearly double the 23% rate of urban hospitals. These gaps underscore how limited IT budgets and legacy systems in smaller organizations hinder data exchange (ONC).

Adoption of interoperability standards (HL7 & FHIR)

• HL7 v2 (the decades-old messaging standard for lab results, ADT, etc.) has near-universal adoption; an estimated 95% of U.S. healthcare organizations still rely on HL7 v2 interfaces for electronic health information exchange (National Library of Medicine).
• In the United States, major EHR vendors were required by regulation to deploy FHIR API endpoints, leading to an estimated 85% of healthcare institutions now having FHIR-based data exchange capabilities (ONC).
• In the UK’s National Health Service, over 75% of healthcare organizations have implemented FHIR-based exchange for data sharing (ONC).
• Across Europe, access to electronic health records has expanded greatly in recent years. As of 2024, 20 out of 27 EU member states (about 74%) reported that at least 80-100% of their population can technically access their own online health records. In 2025, this grew to 23 member states (85%) with near-universal EHR access for citizens (2024 Digital Decade eHealth Indicator Study).

Technical and financial barriers

• The top cited obstacle to improving healthcare interoperability was integrating data from multiple EHR systems, noted by 42% of respondents (2024 HIMSS Market Insights).
• Nearly as challenging was integrating new digital solutions into existing systems and workflows (41%), followed by the difficulty of managing unstructured data like PDFs and medical images (39%) in conjunction with structured EHR data (2024 HIMSS Market Insights).
• Nearly 50% of large hospitals (500+ beds) reported major challenges in integrating patient data across their numerous EHR systems, almost double the rate of small/mid-sized hospitals (2024 HIMSS Market Insights).

Outcomes and benefits of interoperability

• In 2025, 77% of healthcare leaders said that using more interoperable systems has directly improved their operational efficiency, a big jump from 56% who said the same a year prior (HIMSS State of Interoperability and Connected Care report).
• About 60% of organizations in 2025 reported real-time data exchange capability, up from 42% in 2024 (HIMSS State of Interoperability and Connected Care report).

What Makes EHR Interoperability So Difficult in 2026?

EHR interoperability is still a challenge in 2026 because most healthcare systems run on fragmented architectures, inconsistent standards, and workflows that were never designed to connect across organizations. Even with FHIR adoption growing, the ecosystem remains uneven technically, financially, and operationally.

Let’s look at the core issues that continue to slow progress.

Legacy and incompatible EHR architectures

Many hospitals still rely on rigid, monolithic systems built around outdated data models and proprietary formats. These platforms weren’t meant to exchange structured healthcare data with external tools or cloud services. Even when integrations are possible, they often require custom interfaces for every connection. At TechMagic, we frequently support teams that want modern FHIR APIs but are still tied to HL7 v2 message flows buried deep in legacy stacks.

Fragmented data standards and partial implementation

FHIR continues to expand, but real-world implementation is inconsistent. Optional fields, custom extensions, and vendor-specific profiles often break compatibility between systems that claim to support FHIR. Europe and the U.S. also follow different healthcare interoperability guides, which adds another layer of variation for cross-border providers or global telehealth companies. The result: systems technically “speak FHIR,” but not in the same dialect.

High integration costs and resource constraints

Even when the technical path is clear, many organizations don’t have the budget or engineering capacity to maintain continuous healthcare data interoperability work. Building, testing, and monitoring integrations is an ongoing commitment, not a one-time project. Smaller hospitals and clinics often delay upgrades simply because internal teams are stretched too thin.

Example snapshot of common integration investments

Values based on healthcare industry averages and TechMagic project experience; ranges vary by vendor.

Poor data quality and non-normalized clinical documentation

Even the best technical setup can fail if the data itself is inconsistent. Variations in terminology, unstructured notes, missing codes, and incomplete patient records make exchanged information hard to trust. Many hospitals still lack a governance model for terminology management, which blocks downstream analytics and patient care coordination.

Privacy concerns and regulatory compliance barriers

Meeting requirements like the Health Insurance Portability and Accountability Act (HIPAA), ONC certification, GDPR, and local data-sharing laws often slows integration projects. Teams worry about accessing the wrong dataset, sending too much information, or exposing PHI through poorly configured application programming interfaces. This caution is justified, but it adds friction when no clear cross-organizational security model exists.

Vendor lock-in and limited API access

Some EHR vendors still enforce restrictive API policies that limit what third-party solutions can do. Others charge high integration fees or require proprietary tools instead of open standards. This slows innovation and forces hospitals to choose between cost and capability. It’s one of the most common obstacles we see when helping clients extend their systems with modern digital health apps.

Workflow inconsistencies across care settings

Interoperability isn’t just a technical problem; it’s a workflow problem. Hospitals, primary care, urgent care, labs, imaging centers, and home health providers all document differently. Data fields don’t map cleanly. Events aren’t captured in the same way. Even basic elements, like medication lists or problem lists, may follow different internal practices.

Limited cross-organizational governance and collaboration

True healthcare interoperability requires alignment across hospitals, payers, labs, vendors, and state or national networks. But many of these groups operate in patient data silos, each with its own priorities and policies. Without shared governance (standards, terminology rules, data-quality metrics, integration roadmaps), progress happens one project at a time instead of across the ecosystem.

What Are the Key Standards That Enable Seamless EHR Data Exchange?

Seamless EHR data exchange depends on a core set of technical and clinical standards that unify how systems structure, transport, and secure information. In 2026, FHIR-based APIs lead the ecosystem, but legacy standards, terminology systems, and national frameworks still play a major role, especially because the U.S. and Europe follow different regulatory models.

Let’s break down the standards that matter most.

HL7 FHIR as the modern interoperability foundation

FHIR is now the primary engine behind modern EHR interoperability. Its resource-based model, RESTful APIs, JSON/XML formats, and global adoption make it the default standard for exchanging clinical data in near real time. Both the U.S. and Europe rely heavily on Fast Healthcare Interoperability Resources, though implementation guides differ across regions. Most new integrations we build at TechMagic start with FHIR as the foundation.

SMART on FHIR for secure app-level integration

SMART on FHIR adds the security layer: OAuth 2.0, OpenID Connect, and app authorization workflows. It allows third-party apps to run safely inside EHR environments through plug-and-play integration. This is essential for patient-facing apps, e-prescribing tools, care-management platforms, and clinical decision support.

HL7 v2 and v3 as established messaging frameworks

Despite FHIR’s growth, HL7 v2 still drives many core workflows: lab results, ADT messages, pharmacy data, and admissions. HL7 v3 never saw the same adoption, but some national programs (especially older European infrastructures) still rely on it. Many hospitals run hybrid stacks: FHIR for new apps, v2 for operational messaging.

C-CDA and consolidated clinical documentation standards (U.S.)

C-CDA is still central in the U.S. for care summaries, transitions of care, referrals, and discharge documentation. It’s a regulatory requirement under ONC certification. Europe uses similar structures, but C-CDA itself is largely U.S.-centric.

DICOM for imaging data and diagnostics exchange

DICOM remains the universal standard for radiology and imaging interoperability. It governs image formatting, metadata, compression, and modalities across PACS, imaging centers, and artificial intelligence diagnostic tools. Both the U.S. and EU systems use it consistently.

LOINC, SNOMED CT, and ICD for clinical terminology alignment

Terminology standards are critical for structured, computable data:

• LOINC for labs, observations, and measurements
• SNOMED CT for clinical concepts
• ICD-10/ICD-11 for diagnoses and billing

Both U.S. and Europe use these vocabularies, although licensing rules differ. Without them, mapping across systems becomes guesswork.

IHE integration profiles for cross-vendor workflow coordination

IHE profiles such as XDS, XCA, PIX, and PDQ define how documents, identities, and workflows move across organizations. Europe uses IHE extensively for national and cross-border exchange. The U.S. uses it selectively but still depends on it in older HIE infrastructures.

USCDI as the required dataset for certified EHR exchange (U.S.)

USCDI defines the minimum data classes that certified EHRs must support. It ensures consistency across healthcare vendors for demographics, allergies, medications, clinical notes, and more. Each new USCDI version expands required data types (such as social determinants of health, vital sign details, provenance).

TEFCA as the national framework for interoperability (U.S.)

TEFCA governs secure, nationwide data exchange. It sets policies for Qualified Health Information Networks (QHINs) and outlines how organizations share data at scale. It is one of the biggest interoperability shifts happening in the U.S. right now.

API-first interoperability as the architectural standard

API-first design focuses on modular, scalable integration instead of point-to-point interfaces. This includes REST APIs, bulk FHIR exports, event-driven architectures, and standardized authentication. It reduces custom interfaces, improves performance, and supports modern apps, analytics, and automation.

Example snapshot of API-first vs. legacy interfaces

EU-specific standards and the emerging European health data space (EHDS)

EHDS is contributing to interoperability in the EU, setting unified rules for patient access, cross-country data sharing, and health research. Countries still maintain national rules (such as Germany’s MIOs, France’s CI-SIS), but EHDS creates shared technical and governance layers. The U.S. uses USCDI/TEFCA; Europe leans on EHDS, IHE, and national FHIR profiles. The goals are similar (consistent, secure exchange), but the regulatory paths differ.

What Are Best Practices for Healthcare Organizations to Improve EHR Interoperability?

Healthcare organizations can improve EHR interoperability if they adopt open standards, modernize their integration architecture, strengthen data governance, and align workflows across all care settings. The most effective approach combines technology upgrades with organizational coordination.

Let’s walk through the strategies that consistently deliver results in real environments.

Adopt FHIR-based APIs and modern open standards

FHIR-based APIs offer the fastest and most scalable way to exchange clinical data. They support mobile apps, analytics platforms, patient tools, and third-party integrations without heavy custom work.

Example: A hospital connecting remote monitoring devices can use FHIR Observations instead of manually parsing HL7 v2 ORU messages.

TechMagic often helps teams add a FHIR “layer” on top of legacy systems so they can modernize gradually, not all at once.

Build API-first integration architectures

API-first design replaces fragile point-to-point interfaces with modular, reusable services. It lowers integration time and makes adding new partners far easier. Event-driven patterns (webhooks, FHIR Subscriptions) help systems stay in sync without constant batch jobs.

Implement robust data governance and stewardship frameworks

Even perfect APIs fail when data quality is inconsistent. Governance frameworks ensure standardized data formats and vocabularies, consistent mapping, and shared responsibilities across clinical, IT, and administrative teams.

Typical governance activities: code-set management, terminology reviews, and quality scoring for incoming comprehensive data.

Normalize clinical terminologies across all systems

LOINC, SNOMED CT, and ICD must be applied consistently for exchanged data to be usable. Terminology normalization ensures lab values, problems, medications, and notes map cleanly across systems.

Real example: When two hospitals merge, standardizing medication codes prevents duplicate entries and incomplete medication histories.

Leverage integration engines and middleware platforms

Integration engines (Mirth Connect, Rhapsody, InterSystems Health Connect) help route, validate, monitor, and transform healthcare data across systems. They are essential when supporting hybrid environments running HL7 v2, FHIR, DICOM, and proprietary files at the same time.

Standardize clinical workflows across care settings

Advanced technology alone can’t fix workflow misalignment. For smoother exchange:

• Standardize documentation templates
• Align order sets and discharge workflows
• Unify naming conventions and care pathways

This reduces mismatched fields, incorrect mappings, and redundant steps that slow care.

Invest in master patient index (MPI) and identity management tools

Accurate identity matching is the foundation of safe data exchange. MPI systems use probabilistic and deterministic matching to reduce duplicates and ensure every record belongs to the right patient.

Example: Linking EHR + lab + radiology systems without MPI often creates 5-10% duplicate records in mid-size hospitals.

Use cloud-native infrastructure to streamline data exchange

Cloud platforms support scalable, accurate patient data exchange, bulk FHIR exports, near-real-time messaging, and secure data storage. Cloud-native tools also simplify version control, logging, monitoring, and analytics.

This is especially important for organizations managing many external partners or high data volumes.

Enhance data security, privacy, and compliance from day one

Strong interoperability requires a secure backbone. Key practices include:

• Role-based access and least-privilege
• Encrypted API gateways
• Secure audit trails and event logs
• Zero-trust networking
• Automated policy enforcement for HIPAA/GDPR

Security mistakes are far more expensive to fix later in the process.

Collaborate with specialized interoperability and integration partners

Complex integrations and long-term interoperability programs rarely succeed alone. External specialists accelerate system mapping, workflow alignment, architecture modernization, and custom FHIR/API development.

TechMagic supports healthcare organizations with:

• Custom HIPAA-compliant EHR development
• FHIR API design and integration
• Legacy-to-modern architecture migration
• Medplum-based development for cost-efficient yet robust interoperability
• Long-term interoperability program support

What Are the Key Advantages of Achieving EHR Interoperability?

When interoperability works, clinicians make decisions faster, workflows run smoother, and patients receive safer, more coordinated care. Unified data also strengthens analytics and value-based care performance.

Let’s break down the benefits that impact daily operations the most.

Faster, more accurate clinical decision-making

Interoperability gives clinicians immediate access to complete patient histories, recent labs, imaging, and medication data without digging through different systems. Real-time, standardized information reduces diagnostic uncertainty and supports evidence-based decisions at the point of care.

Example: When ED physicians can see outside hospital labs instantly, they avoid repeating tests and speed up treatment.

Reduced administrative burden and workflow inefficiencies

Automated data exchange replaces manual chart reviews, faxed documents, and redundant data entry. Teams spend less time searching for information and more time delivering care. This also reduces transcription errors and lowers the operational cost linked to manual processes.

Enhanced care coordination across providers and care settings

Clean, continuous data helps hospitals, primary care, specialists, labs, imaging centers, payers, and home-health teams stay aligned. Transitions of care stop being a guessing game because every team sees the same source of truth. Interoperability also shortens referral cycles and reduces delays caused by missing documentation.

Improved patient safety through error reduction

Standardized medication lists, allergies, lab values, and problem lists significantly lower the risk of adverse events. When data moves cleanly between systems, healthcare professionals avoid dosing errors, duplicate orders, and conflicting treatment plans. This is one of the strongest and most measurable benefits of interoperability.

Higher patient engagement and better digital experience

Interoperability powers patient portals, mobile apps, wearables, and remote-monitoring tools. Patients gain easy access to their visit notes, care plans, patients' complete medical histories, and lab results. This transparency helps people participate in decisions about their own health and improves satisfaction across care journeys.

Stronger analytics, population health, and value-based care performance

Unified datasets support:

• Risk stratification
• Quality reporting
• Cost-of-care management
• Predictive analytics and valuable insights
• Value-based reimbursement programs

Payers, healthcare providers, and health systems perform better when the underlying data is consistent, structured, and trustworthy.

How TechMagic Helps You Build and Scale Interoperable EHR Solutions

Improving interoperability often requires more than updating standards or adding new APIs. It takes the right architecture, the right integrations, and a team that understands clinical workflows as much as technical design. That’s where TechMagic supports healthcare organizations the most.

We build HIPAA-compliant EHR solutions designed for clean, consistent, and scalable data exchange. Our teams work across FHIR, HL7 v2, C-CDA, DICOM, and modern API-first architectures to help hospitals, digital health companies, and enterprise health systems move from fragmented interfaces to unified, reliable workflows.

If you need a custom EHR platform development, system modernization, or a full interoperability solution roadmap, we focus on practical, real-world execution.

For organizations needing a faster or more cost-efficient path, we also provide Medplum development services to help teams build robust, interoperable, cloud-native healthcare applications without the overhead of traditional EHR systems.

Wrapping Up: What Does the Future Hold for Digital Health Ecosystems?

Interoperability is the groundwork for safer care, enhanced patient care, better decisions, improved health outcomes, and smoother experiences for clinicians and patients. The path forward is clearer than ever: adopt open standards, modernize architecture, strengthen data governance, and connect teams around shared workflows.

In case you’re thinking about how to improve EHR interoperability in healthcare organizations or upgrade legacy systems that hold you back, the long-term goal remains the same: reliable, real-time information wherever care happens.

As the healthcare ecosystem becomes more digital, more distributed, and more personalized, interoperability will continue to be the foundation that supports every new innovation. The future belongs to systems that share data effortlessly and to care models built around the patient, not the software. Connected healthcare systems are the next step toward a safer, more data-driven, and truly patient-centric world.

FAQ

1. What’s the difference between interoperability and integration in EHR systems?

   Integration connects two systems so they can share data in a specific way. Interoperability does more: it ensures that data is structured, standardized, and immediately usable across multiple systems and care settings. If you want to improve EHR interoperability, you need shared standards, not just connections.

2. What are the main standards used for EHR data exchange?

   The core standards include HL7 FHIR, SMART on FHIR, HL7 v2, C-CDA (U.S.), DICOM, and terminology systems like LOINC, SNOMED CT, and ICD. In the U.S., USCDI and TEFCA guide nationwide exchange. In Europe, the EHDS and national FHIR profiles shape how organizations share patient data across borders.

3. How can hospitals improve interoperability without replacing their current EHR system?

   Hospitals can improve EHR interoperability in medical organizations if they add FHIR-based APIs, use integration engines, normalize terminology, improve governance, and adopt an API-first approach. To upgrade EHR interoperability in healthcare smoothly, many teams extend legacy systems with a modern interoperability layer instead of replacing the core EHR.