Interoperability expectations outpaced organisational readiness

Healthcare organisations entered the EHDS era with a clear regulatory direction and a growing set of technical standards intended to enable medical data exchange across systems, providers, and national borders. From a technical standpoint, the building blocks of interoperability are largely in place. Data models exist, interfaces are documented, and vendors increasingly support standardised exchange mechanisms as part of their core offerings.

What continues to lag behind is organisational readiness to use these capabilities in a consistent and reliable way across everyday operations. Despite significant investment in integration platforms, compliance initiatives, and data exchange infrastructure, healthcare systems still struggle to make interoperability work outside controlled or local contexts. Data exchange remains fragmented, inconsistent, and fragile, particularly when information needs to flow across organisational boundaries rather than within a single institution.

This gap persists not because standards are immature or technology is unavailable, but because ownership of interoperability outcomes is rarely defined at leadership level and rarely treated as an executive responsibility tied to care delivery and system performance.

Data moves faster than accountability

In many healthcare organisations, responsibility for interoperability is distributed across IT, compliance, clinical leadership, data teams, and external partners. Each group addresses a specific slice of the problem. IT delivers interfaces and integrations. Compliance ensures regulatory alignment. Clinical teams define local data requirements. Vendors provide technical capabilities aligned with standards.

What remains missing is end-to-end accountability for how data supports decisions, care pathways, and operational coordination across the system. When data quality issues appear during handovers or cross-provider workflows, ownership becomes unclear. When integrations technically function but fail to support real clinical or operational decisions, responsibility shifts between teams rather than being resolved decisively. When data is available but unusable under time pressure, no single role owns the outcome or has the authority to intervene.

As a result, interoperability initiatives create connectivity without coordination. Data flows exist, but decision-making remains fragmented, delayed, and reactive, particularly in situations where speed and trust matter most.

EHDS increased pressure without resolving governance

EHDS raised expectations around cross-organisational data exchange, secondary use of health data, and patient access, pushing interoperability higher on executive agendas across Europe. It formalised obligations, timelines, and reporting requirements, making interoperability impossible to ignore and harder to postpone.

At the same time, EHDS exposed the limits of existing governance models. Most healthcare organisations approach EHDS through compliance programmes focused on legal interpretation, documentation, and system readiness. These efforts improve alignment with regulatory requirements, but they rarely address the more difficult question of who owns data flows across clinical, operational, and analytical contexts once systems are connected.

Governance remains system-centric rather than service-centric. Decisions focus on individual platforms, datasets, or repositories instead of end-to-end data usage within care pathways and operational processes. Without explicit leadership decisions on ownership, prioritisation, and accountability, interoperability becomes a compliance deliverable rather than a practical operational capability that clinicians and managers can rely on.

Interoperability breaks down at organisational boundaries

Within individual organisations, data exchange often works reasonably well. Systems integrate, departments share information, and local workflows are supported by digital tools. The most persistent problems emerge when data must move across organisational, regional, or national boundaries, where governance models and incentives diverge.

At these boundaries, differences in process design, risk tolerance, and accountability become visible. Data that is acceptable and trusted in one context becomes incomplete, delayed, or ambiguous in another. Responsibilities for validation, correction, and interpretation are unclear, particularly when time-sensitive decisions must be made. Escalation paths are slow, informal, or dependent on personal relationships rather than defined structures.

Technology exposes these fractures rather than repairing them, faithfully moving data between systems that organisations are not prepared to govern collectively or operate as a shared service.

Clinical and operational impact depends on leadership decisions

Interoperability is often justified by its potential clinical and operational benefits, including continuity of care, reduced duplication, improved patient experience, and more effective use of limited resources. These benefits depend on timely, reliable, and trusted data exchange that clinicians and operational teams can act on without hesitation.

When governance is weak, clinicians receive partial or inconsistent information that undermines trust and increases cognitive load. Manual verification becomes routine. Workarounds emerge and stabilise over time, with digital exchange supplemented by phone calls, emails, and ad hoc coordination during critical moments. Gradually, interoperability is perceived as an administrative burden rather than a clinical enabler, even when the underlying technology is sound.

Whether interoperability improves care delivery or adds friction is determined less by technical maturity than by leadership decisions around ownership, accountability, and prioritisation.

Technology follows governance, not the other way around

Healthcare organisations that make sustained progress on interoperability begin with governance rather than tooling. Leadership defines which data flows matter most, who owns them, and how accountability is enforced across organisational boundaries. Decision authority is clarified for data quality, access, and usage, including how trade-offs are made when clinical, operational, and regulatory requirements conflict.

Technology then supports these decisions by implementing standards, integrations, and monitoring aligned with agreed responsibilities. Interoperability becomes an operational capability embedded into service delivery rather than a standalone technical project or regulatory obligation.

In this model, EHDS compliance emerges as a consequence of effective governance rather than its primary driver.

Sustainable interoperability requires executive ownership

Interoperability challenges persist when they are treated as technical integration tasks or compliance initiatives delegated away from executive attention. They are resolved when leadership treats data exchange as a core organisational capability tied directly to care delivery, operational coordination, and system resilience.

This requires executives to make explicit decisions about ownership, prioritisation, and risk, and to accept that interoperability success depends as much on organisational design as on technology selection. Without this shift, additional standards, platforms, and integrations increase complexity without delivering consistent value.

FAQ: Interoperability and leadership in healthcare

Why does interoperability remain difficult despite established standards?
Because standards define how data can move, not who is accountable for its quality, interpretation, and use across organisations.

How does EHDS change interoperability expectations?
EHDS increases regulatory pressure and scope but does not resolve governance and ownership challenges within healthcare systems.

Is interoperability primarily an IT responsibility?
No. It requires leadership decisions around ownership, prioritisation, and accountability that extend beyond IT.

Why do interoperability initiatives fail at organisational boundaries?
Because processes, incentives, and risk tolerance differ, and no single role owns end-to-end outcomes. What should healthcare leaders prioritise next?
Defining governance and ownership for critical data flows before expanding technical integration efforts.