How Healthcare Consolidation Exacerbates the Challenges of Interoperability and How Healthcare Leaders Should Address Them

By Drew Ivan

While the healthcare interoperability environment has in many ways become simpler and easier to manage due to the development and adoption of common standards like HL7, FHIR, and the CCD, integration challenges and complexity persist for a variety of reasons. With the healthcare industry constantly evolving in conjunction with activity like industry consolidation (mergers, acquisitions, and divestitures), new medical devices, the advent of clinical apps, and the industry’s shift toward consumerism, it’s no wonder integration complexity is still a significant challenge across the continuum of healthcare. 


One of the biggest sources of interoperability complexity is consolidation. The health organization mergers, acquisitions, and divestitures that hospital leaders are navigating are typically executed with little regard to the obstacles and delays these deals will mean for system interoperability across the reconfigured organization. Though this may sound daunting, the good news is there are several things organizations can do to improve fundamental interoperability so that all types of interoperability initiatives, planned and unplanned, will be far easier to navigate. 

Knowing that even small hospitals can have more than 100 integration points to manage throughout the organization, interoperability challenges are everywhere. This is further complicated when you factor in industry consolidation. When a hospital merges into or acquires another healthcare organization, both entities are expected to work together to begin operating as a unified system. When you think about the frequency at which consolidation activity occurs throughout the industry, a hospital could go through more than one merger, acquisition, or divestiture in a matter of years, and that can be an overwhelming consideration for many healthcare organization leaders. The process is both time-consuming and fraught with opportunity for human error, resulting in frustration for clinicians and administrators alike. 

Provider organization leaders should be concerned with how to integrate as quickly and as accurately as possible, and with how to make their infrastructure ready for new strategies or plans that the organization may want to take on at any given time — for example, implementing new technologies like mobile applications or a customer relationship management initiative for patients.

However, the answer is not to just work harder and get better at consolidating and creating new integrations across a system. Rather, it might have a greater effect on the organization if there was a collective effort to “be interoperable” —  not just simply to do interoperability. Essentially this means organizations should approach interoperability in a way that will not only address present issues, but also help get ahead of and address future challenges. In doing so health organizations can become a kind of universal hub, capable of supporting any initiative or consolidation effort at any given time. That said, most organizations must significantly shift their fundamental approach to addressing interoperability barriers in order to achieve this. 

Healthcare organizations learned a long time ago that using an integration engine reduces complexity of point-to-point integrations, and ultimately creates a central information-sharing capacity within the organization. If two or more organizations are merging, and one is leveraging this type of technology, integrating with the other existing systems is always much easier. This same principle also applies to handling new initiatives and communication protocols, or new devices. The right tools can handle both. In order to stay ahead of industry shifts and organizational consolidation, here are a few key considerations for healthcare leaders to keep in mind as they navigate the inevitable challenges that accompany these events.  

  1. Healthcare is different. A lot of solutions in the marketplace are designed for general technical connectivity or are specific to other industries, but healthcare has its own languages, protocols, and legacy systems to manage — many of which are proprietary. As such, only healthcare-specific integration technology will be appropriate or effective.  
  2. To be interoperable you need internal and external connectivity. The challenge of a merger is making internal systems work together as a combined entity. Similarly, many of the new health initiatives provider organizations are starting to pursue (like consumerism, patient experience, and home health) also exacerbate the pressure to integrate. This is further emphasized with government mandates which are likely to start enforcing data sharing with TEFCA. As such, seamless integration will be an even bigger priority for organizations to address moving forward. 
  3. We don’t know what we don’t know. We have no idea what future challenges lie ahead in healthcare integration. Addressing interoperability in a way that is more holistic can help organizations future proof to best prepare for those unknown challenges. Getting ahead of these inevitable issues, knowing that health IT is constantly evolving and changing, will ensure maximum flexibility and allow organizations to pivot in new directions and work with data in novel ways. 

Drew Ivan is Chief Product and Strategy Officer for Lyniate.

Drew’s focus is on how to operationalize and productize integration technologies, patterns, and best practices. His experience includes nearly 20 years in health IT, working with a wide spectrum of customers, including public HIEs, IDNs, payers, life sciences companies, and software vendors, with the goal of improving outcomes and reducing costs by aggregating and analyzing clinical, claims, and cost data.

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