INTEROPERABILITY ISN’T JUST MOVING THE RECORD. IT’S CLOSING THE LOOP.
Recently, I experienced another healthcare handoff that reminded me exactly why interoperability matters.
A healthcare facility required documentation from another provider before scheduled care could proceed. The facility gave me its fax information so that I could provide it to the other clinician, who would then send the required documentation back.
I found myself wondering whether I should contact the receiving facility afterward just to verify that the documentation had actually arrived.
Why?
Because when a required handoff fails, patients and families often become the people responsible for discovering that it failed.
I’ve experienced the same problem when medical records or imaging needed to move between healthcare organizations. Instead of the organizations communicating directly, I became the person calling departments, collecting transfer information, and carrying instructions between the two systems.
Why was the patient or family member functioning as the interoperability layer between healthcare organizations?
Patients may need to identify where records are located and authorize their release.
But patient authorization should not mean patient orchestration.
And this is not only a VA problem.
After spending years reconstructing my father’s care, I have come to believe this is a much larger healthcare-system problem—one that becomes especially dangerous when care crosses multiple facilities, specialties, community providers, DoD, and VA.
A referral being placed isn’t the endpoint.
A record being faxed isn’t the endpoint.
A community-care appointment being scheduled isn’t the endpoint.
The question should be: Was the handoff completed?
Was the referral received and completed?
Did the receiving provider have the records needed to safely treat the patient?
Did the outside records and results come back?
Were they incorporated into the longitudinal record?
Did the responsible clinician review them?
Was necessary follow-up completed?
And when one of those steps fails, does the system detect and resolve that failure—or does the veteran, patient, caregiver, parent, or grieving family member become the interoperability system?
We talk constantly about interoperability as the ability to exchange health information.
But exchange isn’t enough. We need closed-loop interoperability.
Tomorrow, the House Committee on Veterans’ Affairs will hold its hearing, “Beyond Go-Live: VA Electronic Health Record Modernization Status Update.”
As VA modernizes its electronic health record and healthcare increasingly incorporates automation and AI, I hope we move beyond asking whether systems can exchange information and start asking whether they can recognize when a clinical handoff has failed—and ensure the loop actually closes.
Technology should help identify missing records, failed handoffs, and incomplete follow-up; assign responsibility; escalate unresolved gaps; and verify completion.
Interoperability should not mean: “We can send information.”
It should mean:
The right information reached the right person.
It was reviewed.
Action occurred.
Follow-up happened.
And the system knows the loop is complete.
Because when the system doesn’t own the handoff, the burden falls on the person with the most to lose.
The patient should be the person receiving care—not the middleware holding the healthcare system together.