Case USA114: How a Healthcare Provider Network Mistook EHR Interoperability for Enterprise Architecture

Sunil Dutt Jha
Aug 12
2 min read

Overview:

This case is part of a 120-diagnostic series revealing how healthcare systems have mislabeled compliance-driven data exchange as “Enterprise Architecture progress.”

In multi-hospital provider networks, a recurring pattern is treating electronic health record (EHR) interoperability for regulatory compliance as proof of architectural maturity.

Patient records could be shared between facilities, lab results moved faster, and compliance boxes were checked — yet the enterprise structure linking care coordination, population health management, cost optimization, and partner integrations was never modeled.

P1–P6 Insight Preview:

These six perspectives define how an enterprise connects intent to execution

— P1: Strategy, P2: Business Processes, P3: System Behaviors, P4: Component Governance, P5: Implementation, P6: Business & Technology Operations.

P1 (Strategy): EHR interoperability was positioned as a clinical and operational milestone, but no architecture-led plan tied it to reducing readmissions, improving outcomes, or lowering costs.

P2 (Process): Clinical workflows for data exchange were improved, but referral management, care gap closure, and cross-specialty coordination remained fragmented.

P3 (System): EHR systems weren’t behaviorally integrated with scheduling, billing, analytics, or external partner systems.

P4 (Component): Clinical data repositories, imaging archives, and messaging platforms were governed separately, with inconsistent access rules.

P5 (Implementation): Focus was on meeting interoperability deadlines, while deeper integration with population health and analytics tools was postponed.

P6 (Operations): Business ops saw faster record retrieval, but tech ops still handled significant manual reconciliation and duplicate patient record management.

Stakeholder Impact Summary:

CEO/Health System President – accountable for care quality and financial performance: Limited by weak P1 Strategy — compliance is met, but enterprise-level care and cost metrics remain stagnant.
CIO – responsible for technology strategy and integration: Impacted by P3 System Behaviors and P4 Component Governance — fragmented governance prevents a single, trusted patient record across the network.
Sales Head (Provider Relations) – manages relationships with referring providers and partners: Affected by P2 Processes and P5 Implementation — can promise data exchange but not coordinated patient experiences.
Chief Enterprise Architect – ensures clinical and operational systems align with strategic goals: Confronts P1–P6 issues — interoperability is treated as a compliance checkbox, not a lever for transformation.
Head of Care Coordination – oversees patient transitions and continuity of care: Feels P2, P3, & P6 — must manually coordinate with multiple systems to ensure patient care plans are executed.