Faisal Zain has spent decades at the intersection of medical innovation and patient care, positioning himself as a leading voice in the manufacturing and implementation of advanced medical technologies. As an expert who understands the intricate hardware required for diagnostics and the complex software needed for treatment, he offers a unique perspective on how data flows—or fails to flow—between these systems. In this conversation, we explore the evolving landscape of healthcare interoperability, moving beyond the technical blueprints to address the human element of trust. We delve into the friction points between vision and reality, the significance of the Trusted Exchange Framework and Common Agreement (TEFCA), and the necessary shift from individual data agreements to a collective stewardship that promises to redefine whole-person care.
The world of consumer technology often feels light-years ahead in terms of data portability, yet healthcare operates under much more rigid structures. How does the reliance on frameworks like TEFCA fundamentally change the nature of trust compared to the individual agreements we sign on our smartphones?
In the consumer world, the exchange of information is often a binary transaction between a user and an app, where a quick tap on a screen grants access to a wealth of personal metrics. In healthcare, however, we are moving toward a national scale where trust cannot be left to a simple checkbox; it requires a robust architecture like the Trusted Exchange Framework and Common Agreement, or TEFCA. This framework acts as a foundational bedrock for a vast ecosystem that includes health information networks, providers, federal agencies, and payers, all connecting through a small, specialized group of Qualified Health Information Networks. By establishing these standardized rules of the road, we move away from fragmented, one-off silos and toward a vision where accurate and usable information is available to a patient or a clinician at the exact moment it is needed. It is a transition from a “handshake” culture to a codified system of mutual reliability, ensuring that the data used to make life-saving decisions is as complete as it is secure.
We are currently navigating what many call the “messy middle” of data sharing, where the gap between vision and reality is most visible. Why is the inclusion of community-based organizations and social services creating such significant friction in our current interoperability efforts?
The friction arises because we are trying to weave together entities that operate under very different regulatory and ethical mandates. While health systems are deeply entrenched in the rigors of HIPAA, many community-based organizations or social service clinics may only follow those guidelines voluntarily or operate outside of them entirely. This creates a palpable sense of risk for traditional providers who worry about secondary use—specifically, how a partner might handle or redistribute sensitive patient information once it leaves the clinical environment. Because of this uncertainty, we often see organizations retreating into a defensive posture, sharing only the absolute minimum amount of data and burying progress under layers of overly complex use agreements. It feels like a “trust recession” where the fear of a privacy breach outweighs the potential benefit of integrated, whole-person care, stalling the very innovation we desperately need.
As national policies are implemented in real-world clinical settings, there seems to be a surge in legal involvement that some fear could hamper innovation. How can organizations manage the tension between meeting compliance standards and maintaining the “good faith” interactions required for integrated care?
The translation of high-level policy into daily operations often creates a vacuum of uncertainty, and naturally, where there is uncertainty, there are attorneys. We are seeing a trend where the focus shifts from “how do we help the patient” to “what is the bare minimum required by law,” which can effectively kill the spirit of collaboration. To avoid this downward spiral, organizations must look at TEFCA not just as a set of rules to satisfy, but as a scaffold that allows them to move flexibly between milestones alongside their peers. We need to foster an environment where predictability is a core characteristic; when entities know exactly how enforcement and standards will be applied, they can interact with more speed and less hesitation. If we allow legal scrutiny to dominate the conversation, we risk losing the momentum of the last eighteen months, potentially bringing cross-sector sharing to a grinding halt just as the technical hurdles are being cleared.
It has been suggested that the healthcare industry has largely mastered the technical standards for interoperability and is now struggling with usability. What does this transition to a focus on usability actually look like for a clinician on the front lines?
For a clinician, usability isn’t about whether the data can be sent, but whether the data that arrives is relevant, clean, and actionable within the flow of their work. We’ve seen at major industry gatherings like HIMSS 2026 that the plumbing is essentially finished—the pipes are laid, and the technical standards are in place—but the water flowing through them needs to be filtered. True usability requires a level of trust in the provider’s ability to access and use information appropriately without being bogged down by administrative strain or data de-duplication issues. It means moving away from a world of “data blocking” and toward a future where a physician can see a comprehensive history that includes behavioral health and social determinants, presented in a way that informs a treatment plan rather than creating a wall of noise. When we reach that stage, interoperability stops being a buzzword and starts being a tool that actually reduces the cognitive load on our already overextended medical workforce.
Recent activities from the ONC and the Recognized Coordinating Entity have focused heavily on vetting processes and treatment standards. With 14,214 organizations already live on TEFCA, what is at stake when these definitions are refined?
The stakes are incredibly high because these recommendations affect a massive web of more than 79,000 unique connections that keep our healthcare system interconnected. When the ONC asked for comments in February 2026 regarding who can access information for treatment reasons, they were essentially trying to fine-tune the gatekeeping mechanism for the entire country. If the vetting process is too restrictive, it creates a bottleneck that prevents critical information from reaching those who need it; if it is too loose, the foundational trust of the network could crumble. By engaging with these proposed rules, the community is working to de-duplicate requirements and simplify transactions, which is essential to minimizing the administrative burden that currently plagues our providers. These 14,214 organizations represent the early majority, and their success in navigating these vetting standards will determine whether the rest of the industry follows suit or remains siloed.
The concept of moving from a “blame culture” to “collective stewardship” is a powerful shift in mindset for healthcare executives. What specific changes in governance or liability structures are necessary to make this transition a reality?
We have to move toward a model of shared liability where the entire data-sharing community is incentivized to protect the ecosystem rather than just their own individual interests. Currently, the system is often set up to reward those who can point the finger at a partner when something goes wrong, which naturally discourages open exchange. Instead, we need governance structures that favor transparent data use norms, allowing every participant to see how policies are being translated into real-world actions across the network. This involves creating a framework where joint responsibility is the default, much like the community governance we see in the current TEFCA development process. When organizations feel that they are part of a collective stewardship, they are more likely to share the accurate, complete, and relevant information that is necessary to ensure every patient receives the best possible care.
Interoperability is often discussed in terms of technical success, but the ultimate goal is high-quality patient outcomes. How do you see these data exchanges directly fueling the next generation of value-based care?
High-quality outcomes are the natural byproduct of a system where data is no longer a static asset but a dynamic force that powers value-based care and population health insights. When interoperability is functioning at its peak, we move away from reactive medicine and toward proactive, whole-person care that can predict and prevent health crises before they occur. The technical capabilities we are building now will allow us to gather public health insights that lead to more productive, evidence-based policies on a national level. We will see the narrative shift from the “woes” of data sharing to the tangible success stories of lives saved and costs reduced because a clinician had the right information at the right time. Ultimately, trust in the process is the fuel that will allow these gains to become a reality, transforming the way we perceive and deliver healthcare for everyone.
What is your forecast for the evolution of interoperability over the next decade?
I believe that over the next ten years, we will see interoperability disappear into the background of healthcare, becoming as invisible and essential as the electricity that powers our hospitals. By the mid-2030s, the current friction between HIPAA-covered entities and community organizations will be resolved through more sophisticated, automated consent models that prioritize patient agency without sacrificing clinical speed. We will likely see the number of connections grow far beyond the current 79,000 as wearables and home-based diagnostic tools become fully integrated nodes within the TEFCA framework. The focus will shift entirely from the mechanics of moving data to the ethics of how AI interprets that data to drive population health. We are currently laying the “scaffolding” of trust, but within a decade, that scaffolding will be removed to reveal a seamless, integrated system that treats the patient as a whole person rather than a collection of disconnected symptoms.
