A Real Story to Start
A few years back, I sat in a billing team’s tiny break room, stacks of folders piled high on the table. A coder pointed to a claim stuck in limbo for three months because the hospital never sent over a lab result. It had been faxed to the wrong department. No one noticed.
The amount in limbo? $18,400.
That’s one patient. One test. One missing piece of data.
Multiply that by every patient you see each week, every partner lab, every payer system that’s still not integrated. It’s no wonder that so many revenue cycles feel like they’re running on a hamster wheel.
This is the real price of poor interoperability — it’s not an abstract IT problem. It’s the daily reason claims get denied, patients pay twice for the same test, and your staff stays after hours fixing problems that shouldn’t exist.
Interoperability: What It Really Means
The term interoperability sounds like IT jargon, but it just means your systems — EHR, lab software, payer portals, even patient apps — share data reliably and securely.
At its best, it means:
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Patients don’t repeat tests.
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Payers don’t deny claims for “missing info.”
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Billers don’t spend hours on hold chasing reports.
The reality in 2025? We’re still stuck in data silos. Labs fax test results. Specialists email PDFs. Front desks retype the same demographic info a patient entered online last week. And the billing team pays the price.
The FHIR Promise
You’ve probably heard the acronym FHIR — Fast Healthcare Interoperability Resources. It’s the modern standard for health data exchange. It says, “Here’s a universal blueprint. Let’s all share data the same way.”
In theory, FHIR means an imaging center can send results directly into your EHR. Or you can pull a patient’s full history instantly when they come in from another facility.
In practice? It only works if everyone uses it well — your vendors, your referral partners, your payers, and yes, you.
2025: Where Are We Really?
This year’s numbers tell the truth:
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Over 40% of providers say they still can’t reliably exchange patient data with other systems.
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60% of small practices report they’ve had prior authorizations denied because of missing clinical data.
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$15 billion is estimated to leak out of the system annually because of bad data flow and poor coordination.
And we’re supposed to be the most connected healthcare system in the world.
What the Real Experts Say
When I asked three trusted voices what they see on the ground, they didn’t hold back.
Dr. Ayesha Green, MD — Internist & Digital Health Advocate
“Interoperability fails when it’s treated like an IT checkbox.
I’ve watched large systems invest millions in software but never train staff properly to use it.
Good data sharing is a discipline — not just a tech upgrade.”
James Wu, CPC, CCS — Revenue Cycle Director
“In my world, missing data means missing money.
We once found that 30% of our claim denials could have been prevented if the right lab results made it into the EHR on time.
Now, we use FHIR endpoints to pull labs directly. Denials dropped, cash flow improved, and patients got their follow-ups faster.”
Elena Martinez, JD — Privacy and Compliance Lawyer
“One myth is that HIPAA blocks data sharing. It doesn’t.
HIPAA is designed to protect patients but also to make treatment and payment possible.
The real problem? Bad workflows and unclear consent processes that leave patients confused and staff unsure what’s allowed.”
A Failure That Taught Me a Hard Lesson
I once helped a practice switch to a sleek, all-in-one EHR. The vendor claimed, “Fully integrated with local labs.”
Six months in, we realized that “integrated” meant they’d email a password-protected PDF of lab results — which sat unopened in a shared inbox for weeks.
Denials skyrocketed. Staff morale cratered. Patients were frustrated.
Lesson learned? Test your connections before you trust the sales pitch. Ask your labs, imaging centers, and payers: Are you FHIR-ready? How often do you test your endpoints?
Where the Money Leaks: 10 Common Mistakes
Here’s how data silos become revenue holes:
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Faxing results instead of using secure, real-time data exchange.
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Using an EHR with closed loops — only sharing data inside one brand’s ecosystem.
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No real-time error alerts — you don’t know data’s missing until a denial arrives.
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One-way connections — you can push data out but not pull it back.
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Sloppy patient consent workflows that block legitimate data sharing.
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No staff training on verifying incoming/outgoing data.
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Zero contingency plans for when an API goes down.
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Not joining a regional HIE that could bridge gaps.
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Never auditing payer requirements — rules change constantly.
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Thinking “interoperability” is an IT issue only. It’s everyone’s job.
Action Steps: What To Do This Month
If you take nothing else away, take this checklist:
✅ Audit your data flow.
Map where data enters, where it gets stuck, and who owns each handoff.
✅ Push your vendors.
Ask, “Are all my key partners on FHIR? What’s our testing cadence?”
✅ Join or expand your HIE connections.
Yes, it’s an investment. But so is every dollar you lose in denials.
✅ Rewrite your consent forms.
Make them simple, clear, and comprehensive. Less confusion means fewer bottlenecks.
✅ Set up real-time alerts.
Know immediately when required data is missing.
✅ Train your team.
From front desk to billing, everyone needs to understand their role in data accuracy.
✅ Monitor your denials by root cause.
Look for patterns tied to missing or incomplete data.
✅ Have a fallback plan.
When a connection fails, who jumps in and how?
✅ Communicate with patients.
Explain why their consent matters and how it protects them.
✅ Keep testing.
Technology isn’t static — keep your connections healthy.
Industry “Best Practices” That Might Be Hurting You
It’s time to question the “safe advice” you’ve heard at every conference.
❌ HIPAA is too strict to share data.
Truth: HIPAA explicitly allows sharing for treatment, payment, and operations.
❌ One mega EHR will solve everything.
Truth: One vendor’s system is rarely enough. Smart connections beat big silos.
❌ Patients don’t care.
Truth: Ask any patient who’s had to pay for duplicate tests.
FAQ: What Everyone Asks
Q: Will FHIR alone fix my billing problems?
No. It’s the framework — you still need people, policies, and training.
Q: Should I switch EHRs?
Maybe. But first, push your current vendor for integrations or FHIR upgrades.
Q: Is this really worth the hassle?
Studies show that up to half of denials trace back to poor data flow. Fix that, and your revenue cycle stays alive.
Proof It Works: A Real Case
One multi-location cardiology group joined its regional HIE, negotiated FHIR connections with two labs, and started verifying data gaps daily.
In six months:
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Claim denials dropped by 35%.
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Collections rose by $200,000 per quarter.
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Staff morale improved because they spent less time chasing missing reports.
Interoperability isn’t just buzz — it’s real money, real time, real patient trust.
References — Updated and Verified
1️⃣ HFMA 2025 Denial Trends Report
“Half of all denials stem from missing or incomplete data.”
2️⃣ ONC’s July 2025 FHIR Update
“Updated guidance on patient-centered data exchange.”
3️⃣ Modern Healthcare Real-World Data Exchange Failures
“How hospitals are still struggling with silos.”
Your Call To Action
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About the Author
Dr. Daniel Cham is a physician and medical consultant specializing in medical tech, healthcare management, and medical billing. He focuses on delivering practical, real-world insights to help practices stay financially strong while delivering quality care.
Connect with Dr. Cham on LinkedIn: linkedin.com/in/daniel-cham-md-669036285
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#Interoperability #FHIR #HealthIT #DataSharing #MedicalBilling #RevenueCycle #HealthcareInnovation #PatientCare #HealthEquity #MedicalPracticeManagement
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