Electronic health records cannot be quickly exchanged between healthcare providers.

Alongside the growth of the internet, electronic health record (EHR) platforms arose to facilitate billing care provider services with insurers. The onset of various internet technology companies through the 90’s and early 2000’s brought out great enthusiasm about the prospects of EHR to go beyond billing and enhance quality of care. Leveraging the vast sums of data could theoretically enable care decisions based on predictive analytics and break down the barriers to effective patient-provider communication on health.

Despite the passage of the HITECH Act in 2009 and ensuing widespread adoption of EHR, many of the initial anticipated returns have yet to be realized. At the core of these unrealized gains is the fact that healthcare providers cannot easily transfer data between EHR platforms. In fact, 63% of physicians primarily used fax machines to exchange health data in 2012.

The muted positive effects of EHR can likely be attributed to the lack of true interoperability across different EHR platforms. Aside from impediments to data sharing, there is a great need for the standardization of health IT across care facilities, vendors, and software. Despite innovations like the FHIR standard, which seeks to offer a universal means of exchanging clinical data, there are no easy ways of conducting data transfer across platforms, because many EHR rely on legacy systems built out when EHR was first seen as a tool for billing as opposed to the modern visions of a type of general purpose data collection platform.

The greatest effect of the resulting incompatibility is that data on one EHR may be unreadable in another EHR system due to the lack of standards to enable use of the same data from different portals. More concerningly, some health systems have been found to restrict patient data exchange with out-of-network providers. This practice, known as information blocking, is illegal unless given an exception by the Department of Health and Human Services due to a "reasonable and necessary activity". Despite the risks of such practices legally, some firms may continue to challenge patients and providers with continued blocking and similar activities.