Why Interoperability Remains Elusive: CTO Bob Hackney Weighs In

In a new feature by Healthcare IT Today exploring the main barriers to achieving true interoperability in healthcare IT, Bob Hackney, Chief Technology Officer at PerfectServe, talks about what’s holding the industry back and what has to change for real progress to be made. Here are some key takeaways:

What's standing in the way

Bob identifies several core obstacles that continue to block interoperability:

• Misaligned incentives: Many current incentives favor data hoarding rather than sharing. Vendors often use proprietary formats to lock customers in. Health systems may be saddled with legacy infrastructure that was not built to “play nicely with others.”
• Lack of mandatory enforcement: Without firm requirements, organizations tend toward “half-measure” solutions rather than fully interoperable systems. Bob argues that interoperability needs to evolve from being a “nice to have” into a required standard.
• Standards without consistency: Although momentum is growing for standards like FHIR, inconsistent implementation and lack of enforcement dilute their effectiveness. In Bob’s view, unless there are stronger rules (and consequences), standards remain only loosely helpful.

What needs to change

To move beyond the current stalemate, Bob suggests several pathways:

• Regulatory teeth: Legislation should hold systems accountable. For example, only systems that truly interoperate should be certified.
• ROI-driven alignment: If interoperability efforts don't deliver measurable returns—for patients, providers, payers, and vendors—they risk being deprioritized. Bob believes incentives like reimbursement, accreditation, and certification should be tied to measurable outcomes.

Why this matters—for PerfectServe and beyond

Bob’s views highlight how the healthcare industry needs to shift from isolated, compliance-focused efforts to a broader, more outcome-oriented approach. For PerfectServe, this underscores:

• The importance of designing solutions that not only adhere to interoperability standards, but also prioritize ease of data exchange, open formats, and long-term adoptability.
• The need to partner with stakeholders who share the view that interoperability is essential to delivering efficient, high-quality care.

For opinions from Bob and other industry experts, check out the full roundup at Healthcare IT Today.