How interoperability streamlines the provider experience and supports informed care

Secure data-sharing can reduce administrative burden and help providers deliver more timely, coordinated care

Many providers know the difficulty of seeing a patient without having their full health picture.

A referral arrives, but the specialist's notes are delayed. A patient comes in for a follow-up, but the hospital discharge summary hasn't made it over. Staff spend hours fielding record requests and tracking down documentation, adding administrative burden.

Many administrative processes support care delivery and billing, but payers can reduce the friction associated with them. One critical step is improving interoperability, the ability for different health care systems to securely access, exchange, integrate, and use patient data in a standardized manner. The Aetna® Provider Survey series found that nearly 70% of providers named interoperability and data integrity as their top technology challenge.

Federal interoperability requirements are facilitating an increase in the exchange of health information across the health care ecosystem, helping payers and providers connect through standardized approaches to data sharing using applicable privacy and security safeguards to protect patient information.

The role of interoperability in health care

Interoperability enables quick and simplified data exchange between payers and different providers, streamlining providers' administrative operations while supporting more complete, holistic patient care.

This happens through connections between electronic health record (EHR) systems, health plans, pharmacies, labs and health information exchanges, all places that can hold pieces of a patient's health information. When those systems are connected, information recorded in one place can be accessed where it is needed next, without additional requests.
 

Moving data is only the first step. The real value comes from what providers can do with it the moment it arrives: confirm a diagnosis, authorize a service, or close a care gap during a visit already underway. That shift, from information sharing to action, can improve the experience for both patients and providers.
 

Building the infrastructure for that can be complex. A patient's information often sits across disconnected systems, with different formats and standards, spanning both clinical data, such as diagnoses, medications, and care history, and administrative information, such as coverage details and claims.
 

Comprehensive interoperability goes beyond two systems sending files back and forth. Data must arrive in a form the receiving system can read and use. It also requires payers and providers to build connections, utilize common standards and maintain the infrastructure that keeps data flowing reliably over time. The implementation gap remains significant: As of 2023, about 43% of U.S. hospitals routinely participated in all four elements of interoperable exchange—finding, sending, receiving and integrating patient data from outside sources—up from 28% in 2018, according to the federal Office of the National Coordinator for Health Information Technology.

For providers, interoperability can lead to fewer information gaps before an appointment and less time spent on administrative follow-ups afterward, creating a better overall experience and supporting more informed clinical decision-making. For payers, it means the ability to deliver and receive timely clinical information and insights with providers and build deeper, more collaborative partnerships.

How interoperability reduces administrative friction

Though it is an important piece of providing informed care, patient data retrieval and exchange can drain staff time and slow down claims processing. When health plans connect electronic clinical data directly into their workflows, they can help reduce the burden on providers and staff. The use of interoperable systems has allowed Aetna to avoid more than 107,000 chart requests across 126 health systems from May 2024 to January 2026, and its chart chase rate dropped from 38% in 2023 to 11% in 2026.
 

This connected infrastructure can also accelerate other administrative processes, including prior authorization. As part of industry-wide commitments to simplify prior authorization, Aetna has committed to reducing reviews, streamlining approvals and using interoperable technology to support providers and patients. When the information needed for a decision is already available, approvals that once required days or extensive forms can move more quickly.
 

At Aetna, early progress reflects that shift: The company now processes the majority of eligible prior authorizations in near real time and has eliminated more than a million provider phone calls through automation and digital tools. For provider offices, this results in a substantial reduction in administrative work, with fewer calls to make and fewer staff hours spent pulling and sending records.

How interoperability supports better care for patients

Through tools such as provider access application programming interfaces (APIs), eligible providers can request certain payer-maintained data through their electronic health record systems. This gives them a more connected view of a member’s health history and reduces the need to chase records across systems and payers.
 

Interoperability can also move information in both directions. Payers can embed clinical gap alerts directly into providers' existing workflows, so quality and risk insights appear at the point of care. For example, a provider might learn that a patient is overdue for a recommended screening and address it during a visit that's already underway, instead of through later outreach. In the Q2 Aetna Provider Survey, real-time patient data was the single most requested action providers want from payers (29%).
 

Interoperability also supports value-based care. With a fuller view of a member's health and coverage, care teams can better focus treatment and outreach, particularly for patients with complex or urgent needs or those at high risk of developing certain conditions. Seamless data exchange and connection enable coordinated care across multiple providers and help teams build care plans around each patient’s holistic needs.
 

The impact of interoperability grows with the breadth of the network. More providers benefit from near-real-time data exchange, and more patients receive care informed by a full clinical picture.

Interoperability: The connective tissue of a simpler health system

When payers treat interoperability as a central part of partnership, providers gain a more streamlined administrative experience and a powerful data exchange that supports more coordinated, informed care. The result can be near-real-time prior authorization decisions, care gaps addressed during existing visits, and care teams that can see a more complete patient view at once.

As the industry moves toward a more connected future, interoperability will help enable a health care system that works better for patients and the providers who care for them.