By Melissa Kotrys, CEO, Contexture
LinkedIn: Melissa (Rutala) Kotrys
LinkedIn: Contexture
Comprehensive, seamless interoperability has been healthcare’s shared goal for decades. Progress has advanced across multiple fronts, yet health information sharing that is complete, accessible and meaningful to everyone who needs it is still not fully in reach.
Part of the challenge is how the problem is framed. Interoperability is often treated as a single, national objective. In reality, it is also a local one. National and local initiatives must work in tandem, because when they are considered separately, gaps emerge at the local level that limit impact.
Scale and proximity
National interoperability initiatives are essential. They enable connectivity and data exchange across EHRs, state lines and multi-state systems for important use cases such as treatment and other HIPAA-covered uses. At the same time, they are not designed to address every dimension of how information is collected, transmitted, analyzed, and delivered at the state and community level.
This is where statewide and regional health data utilities (HDUs) play a different but complementary role. Because HDUs are governed by the communities and organizations they serve, decision-making reflects local priorities, relationships, and trust. The stakeholders shaping governance are the same ones whose patients, members and residents depend on health data exchange working well.
That community accountability also shapes how HDUs manage consent, an area where a single national standard can only go so far. Consent looks different across 50 states. Substance use treatment records protected under 42 CFR Part 2, state-specific opt-in and opt-out frameworks, and evolving behavioral health privacy requirements each reflect distinct local realities. HDUs are built to navigate that complexity, adapting to the specific legal and regulatory environment in each state they serve.
Where HDUs deliver
Smaller and independent providers, including rural practices, behavioral health organizations and safety-net clinics, often face connectivity and workflow gaps that national standards alone don’t resolve. HDUs are built to close those gaps, and the results are concrete.
During the COVID-19 pandemic, for example, the regional HDU leveraged existing infrastructure to support a statewide acute bed capacity dashboard in Arizona. Using mechanisms already in place, the system provided visibility into hospital capacity within weeks. That same approach has since supported a statewide crisis bed registry, helping providers identify available resources for patients in need of crisis services or other high-acuity care.
HDUs also support integrated data analytics by bringing together clinical and social data. In Colorado, this approach has helped confirm that emergency department utilization decreased in the six months after a social need was met. Unmet social needs such as lack of transportation, food access, or cooling during extreme heat can be addressed through closed loop referral systems, such as the Community Resource Network in Colorado and the CommunityCares program in Arizona. These insights allow stakeholders to design more targeted interventions with meaningful impacts on healthcare costs and outcomes.
In addition, HDUs support identity management through statewide master patient indexes, enabling use cases that extend well beyond data accuracy. In Colorado and Arizona, HDU identity infrastructure has supported state agencies in linking individuals across state programs and public health registries. This capability has enabled “eligible but not enrolled” analysis to identify individuals who qualify for Medicaid, SNAP, or WIC but are not yet participating, so outreach can reach people before a health crisis.
This is interoperability in practice. Not just moving data but making it usable.
Invest in infrastructure that serves everyone
The advancement of national health data networks, including the Trusted Exchange Framework and Common Agreement (TEFCA), is a meaningful step forward. So is continued investment in the local infrastructure that ensures national progress translates into real-world impact for every patient, provider and community.
HDUs offer local expertise, flexible infrastructure and robust governance that support trust, innovation and responsiveness. National frameworks provide scale beyond the geographies that an HDU serves. HDUs ensure that scale reaches the people it is meant to serve.
Interoperability does not succeed when data simply moves. It succeeds when it works for the people and communities it is meant to serve.