CHICAGO, January 8, 2026 (Newswire.com)
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A new Black Book® flash survey of 290 validated healthcare stakeholders finds that while interoperability headlines often emphasize national frameworks and HL7® FHIR® APIs, the “last mile” of cross-continuum exchange remains stubbornly manual for many organizations, especially across behavioral health, post-acute/long-term care, public health, and community-based organizations (CBOs).
Respondents spanning health systems, behavioral health providers, post-acute and long-term care organizations, public health stakeholders, and CBOs report that practical data-sharing workflows continue to rely on a patchwork of fragmented systems, document-only exchange, and manual reconciliation rather than consistent structured, computable integration into clinical and operational systems.
National progress is measurable: routine use and last-mile participation remain uneven
Federal and industry measures show real gains in hospital interoperability overall, but also highlight why “routine” use and cross-continuum participation remain hard to operationalize. In 2023, 70% of U.S. non-federal acute care hospitals engaged in interoperable exchange routinely or sometimes, while 43% reported doing so routinely; however, even where outside data is available, only 42% of clinicians used that information at the point of care, underscoring the persistent gap between connectivity and workflow adoption.
At the same time, national exchange infrastructure is continuing to mature. For example, TEFCA’s first designated Qualified Health Information Networks (QHINs)-eHealth Exchange, Epic Nexus, Health Gorilla, KONZA National Network, and MedAllies-were designated in December 2023, expanding a “network-of-networks” foundation for broader exchange.
Black Book’s survey findings suggest that the remaining barriers are less about whether standards exist and more about whether the last mile can afford, implement, and operationalize exchange in ways that work across real-world transitions of care.
Snapshot of long-tail interoperability (Black Book panel poll results, Q4 2025)
In the flash survey:
71% of respondents (206 of 290) say their behavioral health, skilled nursing, home health, hospice, rehab, and public health partners still have “limited” or “no” ability to exchange structured, computable data.
64% (186 of 290) report that CBOs addressing social needs (food, housing, transportation) are only lightly connected (or not connected at all) to clinical data flows.
Only 18% (52 of 290) say their organizations can routinely exchange structured, computable data with most long-tail partners today.
What’s driving the “manual last mile” (multiple responses allowed)
When asked about their biggest interoperability frustrations:
59% (171 of 290) cite integration or transaction fees (e.g., interface costs, per-transaction charges, or incremental connection pricing).
52% (151 of 290) point to partial or immature APIs that do not support real-world use cases (for example, incomplete data elements, limited search/filtering, and inconsistent eventing or subscription patterns).
46% (133 of 290) cite slow vendor onboarding and implementation timelines as a primary source of friction.
By contrast, only 23% (67 of 290) identify the absence of technical standards as their primary obstacle.
Why this matters: post-acute and behavioral health sit on high-stakes transitions
“The last mile is not peripheral,” said Doug Brown, Founder of Black Book. “It is where transitions of care, medication and problem list reconciliation, referral loop-closure, and population-level reporting often fail.” The financial and operational footprint of post-acute care underscores the scale: Medicare alone estimates $29 billion in program spending for skilled nursing facility care and MedPAC reported $16.1 billion in Medicare payments for home health care and $8.8 billion for inpatient rehabilitation facilities.
Momentum is strong: execution details are the bottleneck
Despite persistent gaps, the survey also points to clear momentum:
78% of respondents (226 of 290) say their organizations are more committed to data sharing with long-tail partners than three years ago.
82% (238 of 290) rank improved connectivity to behavioral health, post-acute, and community-based organizations as a top-three interoperability priority for the next 24 months.
“The market has made real progress on the core rails for standards, frameworks, and connectivity, but the last mile is still too often manual for behavioral health, post-acute, public health, and community partners,” said Brown. “Our panels are not describing a lack of intent. They’re describing fixable execution issues: pricing that discourages participation, onboarding that moves too slowly to meet operational needs, and APIs that look complete on paper but fall short in production workflows. Closing those gaps is how the industry turns ‘interoperability’ into consistent, day-to-day care coordination.”
Complementing vendor-sponsored outreach with user-level workflow reality
Much of today’s interoperability narrative is shaped by vendor marketing, sponsored surveys, conferences, and recognition programs. Black Book’s flash survey is designed to complement those efforts with independently gathered, user-level feedback focused on the practicality of exchanging structured data with long-tail partners, particularly where organizations must connect across multiple vendors, limited IT staffing, and constrained budgets.
This Black Book flash survey used a rapid-cycle, online methodology with screening to ensure respondents had direct involvement in interoperability and data exchange within their organizations. With 290 qualified respondents, the findings carry an approximate margin of error of ±6 percentage points at a 95% confidence level and are intended as directional insights rather than precise measurements. Results reflect self-reported experiences and perceptions at the time of fielding. Key characteristics of the flash survey include: participants across health systems, behavioral health, post-acute and long-term care, public health, and CBOs; Confidential, unaided evaluations, rather than vendor-nominated references or sponsored outreach; and workflow emphasis on onboarding experience, the economics of connectivity, and the day-to-day feasibility of structured exchange beyond document sharing.
About Black Book®
Black Book® is an independent healthcare market research and intelligence firm specializing in user-driven insights on technology, services, and digital health. Since 2011, Black Book has gathered millions of evaluations from healthcare professionals worldwide, producing rankings, satisfaction scores, flash surveys, and market analyses to support better-informed decisions. Industry stakeholders can download complimentary Black Book insight reports at www.blackbookmarketresearch.com
SOURCE: Black Book Research
Source: Black Book Research