Interoperability projects: the project manager's approach
Interoperability means that patient data moves securely between systems, organisations and patients themselves, and still means the same thing when it arrives. In US healthcare it is no longer optional: the 21st Century Cures Act, ONC certification rules and CMS interoperability rules make data sharing a legal duty and, in many cases, a condition of payment.
For a project manager, interoperability projects are unusual because the hardest parts sit outside your own organisation. You depend on outside vendors, health information exchanges, payers and app developers, and the data you exchange is only as good as the clinical workflows that create it.
The standards you will work with
HL7 v2
Message-based standard behind most hospital interfaces: admissions (ADT), lab orders and results, billing feeds.
PM note: Still the backbone of most interface work. Every site uses it slightly differently, so plan for interface specs and mapping per partner.
FHIR (R4)
Modern API standard using web-style resources (Patient, Observation, MedicationRequest).
PM note: Required for certified patient-access APIs. Scope by resource and by US Core profile, not by 'turn on FHIR'.
C-CDA
Structured clinical documents such as discharge summaries and continuity-of-care records.
PM note: Used for transitions of care and HIE exchange. Test document quality, not just delivery.
USCDI
The US Core Data for Interoperability: the defined list of data elements that must be shareable.
PM note: New USCDI versions add elements. Treat each version as a scoped release with its own data mapping work.
TEFCA / QHINs
National framework connecting networks through Qualified Health Information Networks.
PM note: Joining is mostly legal agreements, onboarding and testing with your chosen QHIN. Legal review sits on the critical path.
Direct messaging
Secure email-like exchange between providers.
PM note: Cheap and widely available, but adoption depends on provider directories being accurate.
The rules driving the work
Information blocking rules (Cures Act)
Providers, developers and HIEs must not unreasonably interfere with access, exchange or use of electronic health information.
What it means for your project: Shapes how fast results are released to patients and how data requests are handled. Needs policy, workflow and IT changes together.
ONC certification (HTI rules)
Certified EHRs must support standard FHIR APIs, USCDI and decision-support transparency.
What it means for your project: Vendor upgrades drive your timeline. Your project is often the local rollout of a vendor's certified release.
CMS Interoperability & Prior Authorization rule
Payers must offer Patient Access, Provider Access, Payer-to-Payer and Prior Authorization APIs on phased dates.
What it means for your project: Hard regulatory dates for payers; providers must be ready to consume the new APIs.
Promoting Interoperability (Medicare)
Hospitals and clinicians report measures such as e-prescribing, HIE exchange and patient access.
What it means for your project: Poor performance reduces Medicare payment, so measure reporting belongs in the project scope.
State HIE and public health reporting
Immunisation registries, syndromic surveillance, electronic lab and case reporting.
What it means for your project: Each state has its own onboarding queue and testing process. Start early; queues take months.
A six-phase delivery approach
- 1
Define the use case and value
2–4 weeks- Write each use case as 'who needs which data, when, to do what' — e.g. 'ED physician sees outside medication list at triage'.
- Link each use case to a regulation, a measure or a clinical outcome.
- Agree the executive sponsor and a clinical owner per use case.
Output: Use-case register with priority, driver and owner.
- 2
Inventory systems and partners
3–6 weeks- List every source and destination system, interface engine and external partner.
- Record current standards, versions and who supports each interface.
- Identify partners with their own release calendars and onboarding queues.
Output: Interface and partner inventory with dependency map.
- 3
Governance and agreements
4–12 weeks (runs in parallel)- Set up a data governance group: privacy, security, HIM, clinical informatics, IT.
- Track data use agreements, BAAs and network participation agreements as critical-path items.
- Decide consent and sensitive-data rules (behavioural health, 42 CFR Part 2, adolescent data).
Output: Signed agreements and a data-sharing policy.
- 4
Design and data mapping
4–10 weeks- Map local codes to standard terminologies (LOINC, SNOMED CT, RxNorm).
- Define patient-matching rules and how mismatches are handled.
- Write interface specifications and get sign-off from both sides.
Output: Signed interface specs and terminology maps.
- 5
Build and test
6–16 weeks- Run unit, partner connectivity, end-to-end and clinical validation testing.
- Test with realistic volume and edge cases: merged patients, corrected results, duplicates.
- Have clinicians confirm incoming data appears where they work, not in a hidden tab.
Output: Test evidence and clinical sign-off.
- 6
Go-live and monitoring
2–4 weeks, then ongoing- Go live partner by partner, not all at once.
- Monitor message queues, error rates and match rates daily during hypercare.
- Hand over to an interface support team with clear runbooks and escalation paths.
Output: Live interfaces, support model and usage dashboard.
Worked example: connecting a 4-hospital system to the state HIE and a QHIN
A regional health system with four hospitals and 60 clinics wants outside records to appear in its EHR for ED and primary care, and must improve its Promoting Interoperability scores. Budget is about $1.2M over 9 months. (Illustrative figures.)
- Month 1: The PM defines three use cases — ED outside records, discharge summaries to community PCPs, and immunisation history from the state registry. Each gets a clinical owner.
- Months 1–3: Legal review of the QHIN participation agreement becomes the longest task. The PM escalates it to the sponsor in week 5 because it threatens the test window.
- Months 2–4: Informatics maps 1,400 local lab codes to LOINC. 18% need manual review; the PM adds two contract analysts rather than slip the date.
- Months 4–6: Testing finds a 7% patient-match failure rate caused by missing middle names and old addresses. Registration workflow is changed before go-live.
- Month 7: Go-live at one hospital ED first, then the rest two weeks apart. Hypercare tracks query volume and how often clinicians actually open outside records.
- Months 8–9: Usage in the first ED is only 22% because the outside-records button is buried. A small EHR layout change lifts it to 61%.
Result: All four hospitals live in 8.5 months, match rate above 97%, and the system's HIE exchange measure moves from failing to passing. The lesson: the technical connection was 40% of the effort; legal, data quality and clinical workflow were the other 60%.
What to measure and report
Patient match rate
Unmatched records mean data arrives but no one sees it.
Interface error and retry rate
Early warning of mapping or partner problems.
Clinician usage of outside data
The real measure of value; connection alone is not success.
Time to release results to patients
Evidence for information blocking compliance.
Promoting Interoperability measure scores
Directly tied to Medicare payment.
Partner onboarding cycle time
Shows whether governance and testing are a bottleneck.
Common pitfalls and how to prevent them
Treating it as a pure IT project
Put a clinical owner on every use case and measure clinical usage, not just message counts.
Legal agreements discovered late
Start agreements in week one and track them on the critical path with named legal owners.
Poor patient matching
Fix registration data quality before go-live and agree how unmatched records are reviewed.
Data that arrives but is unusable
Test with real clinical scenarios and make sure data lands in the clinician's normal workflow.
Partner delays you can't control
Phase go-lives by partner, and keep a partner-by-partner readiness tracker in the steering pack.
Sensitive data shared incorrectly
Define consent and segmentation rules early and test them explicitly, including Part 2 data.
Frequently asked questions
- What does a project manager do on an interoperability project?
- Defines use cases with clinical owners, maps systems and partners, drives legal agreements, coordinates data mapping and testing across organisations, and runs a phased go-live with usage monitoring.
- Is FHIR replacing HL7 v2?
- Not soon. FHIR is required for modern APIs and patient access, but most hospital interfaces still run on HL7 v2. Most projects use both.
- How long does an HIE or QHIN connection take?
- Typically 6–12 months for a health system, with legal agreements and partner onboarding queues usually being the longest tasks.
- What is information blocking?
- A practice that unreasonably interferes with access, exchange or use of electronic health information. The Cures Act prohibits it, with some defined exceptions.
- What skills help a PM in interoperability?
- A working knowledge of HL7, FHIR and USCDI, comfort managing external partners, and the ability to translate between clinicians, legal teams and interface engineers.