The tsunami of digitisation is sweeping across the healthcare sector, transforming every aspect of care delivery that we did not fathom could happen years ago. As digital technologies change the practice of medicine with better efficiency and quality, a great divide has emerged between our vision and the reality of digital health.

The healthcare ecosystem continues to exist in a fragmented, inefficient, and ineffective nature despite the majority of health organisations today use electronic health records (EHR). More than 95% of hospitals in the United States and most primary care practices in many European countries already have access to such a system (1,2), yet much patient information still has to be shared manually.

Ironically, after years of effort and billions of investment, healthcare has only changed from a silo, paper-based industry to a digitally fragmented alternative. Indeed, the urgency to link different stakeholders into an integrated network of care has made interoperability a necessity in any EHR procurement consideration.

Interoperability as a procurement product

System-wide interoperability requires system-wide collaboration. Thus far, healthcare organisations have yet to explore procurement approaches to realising interoperability goals. The National Academy of Medicine (NAM) has published a report to address this issue, which provides valuable insights into strategic acquisitions of various health technologies and digital applications (3).

Among the problems identified in the report includes a narrow understanding of interoperability. Most procurements focus on the acquisition of a single module or system that caters to specific departments, such as the surgical theatre or the primary care clinics. The focus is inadvertently misplaced and myopic, that it foregoes the larger picture of achieving cross-organisation interoperability that connects all clinical and non-clinical elements of the ecosystem. This narrow definition of interoperability is obsolete and must be avoided.

Admittedly, in selecting the right EHR vendor, a long term strategic road map must be in place. Health organisations should only consider EHR vendors that can provide well-supported and well-developed solutions that can cater to system-wide demand for interoperability.

Interoperability as a long-term strategic goal

Achieving interoperability should never be mistaken as a short-term sprint. This mentality is mission-critical for both healthcare organisations and EHR vendors. Interoperability must exist in all levels of healthcare, namely between-facilities, within-facility, and at the point of care (3). Equally important is the vendor’s commitment to accountability in the implementation, maintenance, and continuous improvement of their system to meet interoperability requirements.

At Cambio, our COSMIC EHR system exemplifies our commitment to always meeting interoperability requirements. The system has been implemented by health systems across the entire care spectrum from tertiary hospitals to primary care clinics and could provide seamless connectivity to both physicians and patients in accessing critical health information. In particular, our third-generation medication module demonstrated our promise to continuously enhance the system’s usability.

Experience counts in the sea of uncertainties

Another critical aspect in procuring interoperable systems is the vendor ability to handle the complicated web of interactions required to operate an organisation efficiently.

Understanding the communication between technology and clinicians, and the interdependency between the two is a challenging task. Healthcare organisations must understand how implementing an organisation-wide, interoperable EHR system could impact the way data is captured and exchanged, and how these activities could influence the care pathway or decision-making algorithms. Each healthcare sub-ecosystem (primary, secondary, and tertiary care) will have different interactions and require a different approach to achieving interoperability.

Additionally, the use of industrial “standards” does not guarantee interoperability as the interpretation of such a standard may differ, according to the NAM report.

As such, having a vendor-partner such as Cambio with extensive and in-depth experience could be a reassuring factor. In particular, Cambio’s extensive cross-country customer base showcases our ability to comply with prescribed standards beyond the geographical boundary and ensures the COSMIC system is interoperable at all levels required.

Investment today, interoperability tomorrow

System-wide interoperability is likely the biggest challenge of healthcare today. While rapid digitisation cannot guarantee comprehensive connectivity within the industry, healthcare organisations must adopt a different strategy in their procurement and acquisition of technologies which prioritise interoperability. Only when the entire industry commits to this interoperability-driven approach, then we can better safeguard patients’ wellbeing with quality and efficient care.

Health at a Glance: Europe 2018 – State of Health in the EU Cycle – en – OECD [Internet]. [cited 2019 Nov 25]. Available from:
Parasrampuria S, Henry J. Hospitals’ Use of Electronic Health Records Data, 2015-2017. 2019;(46):13.
Procuring Interoperability: Achieving High-Quality, Connected, and Person-Centered Care [Internet]. National Academy of Medicine. [cited 2019 Nov 25]. Available from: