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Interoperability in healthcare means making healthcare data easier to access and exchange across healthcare systems, health plans, healthcare providers, and EHR systems so patients can see a patient’s health record and care teams can coordinate without manual workarounds. New data-sharing requirements are forcing that shift, and plenty of healthcare organizations are treating it like a deadline to clear when it’s really a process worth getting right.
For payers, providers, health systems, hospital systems, and the customer service and support teams that handle the fallout, healthcare interoperability is not just a compliance task. It changes how electronic health records, health information exchanges, and multiple systems share healthcare information and health data, and whether patients get fast, transparent access or end up calling for answers. Patients should be able to see their own health information without jumping through hoops. Providers shouldn’t have to fax records back and forth like it’s still 2005.
The intent is simple. The operational reality is messier, and it tends to get treated as an IT project or a legal sign-off rather than something that needs fixing. But the real experience of the rule gets delivered by whoever answers the phone. That’s where the pressure lands first.
The shift is already underway: 65% of individuals nationally were offered and accessed their online medical records or patient portal in 2024, according to the Office of the National Coordinator for Health IT (ONC). More patients pulling their own records means more inbound requests, and those need handling fast, not funneled through a slow manual process that turns a simple ask into a frustrating one.
Patients increasingly compare their health plan to their banking app where pulling up information takes seconds. A payer that can’t match that baseline is going to hear about it.
Standardization sounds like a technical detail, but it is really one layer of healthcare interoperability. Foundational interoperability allows data transfer between systems without interpretation, so information can move even before it is normalized. Structural interoperability standardizes data formats so multiple systems can exchange information consistently, including through fast healthcare interoperability resources. Organizational interoperability depends on governance, policy, and health information technology innovations, not just the tools moving data around.
Patients don’t call compliance when something feels off. They call customer service. Support lines feel this shift before anyone in legal or compliance even notices the numbers moving. Since a confused patient doesn’t wait for a root-cause investigation, they just pick up the phone.
When shared records are missing across healthcare systems, patients feel it in repeated tests, missing details, and fragmented follow-up instead of seamless care through health information exchanges. When a gap surfaces instead, it reads as incompetence, even though it’s usually just a systems issue nobody’s fixed yet. Interoperability gaps can also delay emergency decisions and weaken medication safety when current electronic health records are unavailable to flag allergies or drug interactions.The stakes are real: J.D. Power’s 2026 Commercial Member Health Plan Study found members who called their claims resolution experience excellent scored 120 points higher on satisfaction than those who called it merely great, and 330 points higher than those who called it just okay or poor. How smoothly one interaction goes swings loyalty dramatically.
Meeting the letter of a new rule without cleaning up the process behind it tends to backfire. CMS’s direction isn’t subtle: a proposed 2026 rule would require electronic prior authorization decisions within 24 hours for urgent requests and 72 hours for standard ones, plus public reporting of approval rates and decision timeframes. “Last year, we got 80 percent of the insurance industry to agree to eliminate prior authorization on common medical services,” HHS Secretary Robert F. Kennedy Jr. said announcing the proposal, a sign of how fast the bar is rising. A rule satisfied on paper but not in practice just moves the problem downstream, into a call with a confused patient.
These rules are already in effect or phasing in, and patient expectations are shaped by everything else in their day, fast, transparent, easy to understand. When a health plan can’t clear that bar, patients rarely blame the regulation. They blame the plan. J.D. Power’s 2026 study backs this up: only 30% of commercial health plan members say their health plan is a trusted partner in their health and wellness.
That’s the real risk, not the compliance deadline itself, but what happens to trust in the gap between technically compliant and genuinely usable. A plan can pass every audit and still lose a member over a bad call about missing data, because the patient on the other end doesn’t know or care whose system failed.
Handling this well starts with the data, not the phone call. Clean, consistent healthcare data matters partly because many healthcare organizations are trying to modernize while still working around legacy systems. Clean, consistent records mean fewer gaps for a patient to stumble into. Limited budgets often slow interoperability improvements even when the operational need is clear. And when a patient does call, the person answering needs enough context to resolve it on the spot instead of escalating something that should have been routine.
Peak Outsourcing helps health plans manage exactly this kind of load. Our data processing and entry teams keep patient and provider records clean and consistent, so gaps are less likely to surface as a frustrated call. Our reporting and analytics support flags patterns in patient inquiries before they turn into a broader trend of complaints, and our CRM administration keeps interaction history organized, so agents aren’t starting from zero.
In a recent healthcare engagement, Peak helped a client reduce administrative processing time by 30% and cut scheduling and information-related errors by 25%, the same kind of cleanup that reduces the “why don’t you have this” calls health plans are starting to see more of.
Peak Outsourcing has been building scalable outsourcing solutions for 15+ years. As a high-growth, private equity-backed company, we’re built to pivot quickly when regulatory or operational demands shift, more responsive than a lot of traditional BPOs manage to be.
Our teams work as an extension of a health plan’s own operation, trained on the specific workflows they support, not treated as a generic call center. Every engagement comes with a dedicated client services manager working directly with your team, not just to execute the work, but to keep finding ways to improve it as requirements evolve. Our leadership team brings direct, hands-on experience across insurance, healthcare, and other regulated industries, real operating experience, not just outsourcing theory.
If your team is bracing for more patient data requests and more “why don’t you have this” calls, we’re happy to talk through what a more prepared operation could look like.
Requirements vary by plan type and size across healthcare organizations and healthcare providers, including health plans and related entities, so it’s worth confirming your specific obligations rather than assuming a blanket rule applies. Patient expectations are rising regardless of the exact regulatory scope.
Delays create real frustration, often a support call. A clear process for acknowledging the request, setting expectations, and recognizing that timely access to a patient’s health record affects patient experience as much as the eventual resolution matters.
Ongoing training tied to actual rule changes, not a one-time onboarding session, paired with clean, well-organized data on the backend, so agents aren’t working around system gaps mid-call.
Your company may benefit from outsourcing certain functionality that you currently perform in-house. The resulting benefits can transform the way you do business and provide a greater focus on your core business functions.
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