Historically in healthcare technology, we follow a pattern of uncertainty: Prove to me that it works, and then I’ll decide what minimal amount of information you need once I’ve verified that you’ve made a strong enough case. While this stance is designed to keep everyone safe, it also stymies the ability for interoperability to address real problems in lockstep with the speed of care. Instead of allowing transparency to guide us, healthcare as a sector doubles down on a stance more akin to “guilty until proven innocent.” The result? We’re hurting ourselves, clinicians, patients, payers and progress along the way. 

What interoperability Can Learn from eBay

If you look at how people actually behave with technology and essential information (including high-value information such as financial and identity), trust is still vital but isn’t usually the first step. Let’s consider how eBay operates. Sellers and buyers are essentially anonymous, goods aren’t always verified, and there’s no established history between both parties. Yet millions of transactions happen daily, and according to data from 2025, eBay moves approximately $219 million in goods every day. eBay’s differentiator, like so many other platforms, starts with transparency, convenience and reliability. Operating guardrails and expectations run on trust, which is further reinforced by positive experiences. It’s not perfect, but it also doesn’t assume perfection is required to exist. Bad actors are identified and cycled out quickly, maintaining a high integrity system.

In healthcare, it’s easy to point to the equivalent operating guardrails as the issues holding back interoperability, including Trusted Exchange Framework and Common Agreement (TEFCA), bandwidth, application programming interfaces (APIs), or Fast Healthcare Interoperability Resources (FHIR) versions. While policy, regulation and technology adoption can be challenging for some entities, progress is more often halted due to what happens after: Data starts being exchanged. In a context where every piece of information shared opens the door to real risk, turning on the data sharing taps is an intimidating prospect. In healthcare, every transaction and every request could have a negative consequence. Is the network trustworthy? The framework? Governance? Entity? Individual? In short, healthcare’s stance is that if you don’t fully understand something, or if there’s uncertainty, you should just not exchange any information and prevent risk exposure before it starts.

When any organization that holds critical information, like the largest family doctor, decides that information can’t be shared, the vision of interoperability starts to crumble before it even gets started, breaking down every step of the process. Patients and providers experience slow-moving prior authorizations that can risk lives. Providers ask for records that already exist, slowing down care. Forms and paperwork have to be repeated, doubling the workload for already overburdened providers. Coverage gets denied after treatment has been rendered. 

The system looks disconnected, slow, confusing and full of holes: Suddenly, the system that was designed to be trusted feels critically untrustworthy, not because care providers are not able to connect the dots, but because they believe the risk outweighs the benefit to doing so. In turn, providers struggle to trust payers when determining treatment plans, and patients become untrusting of their providers and disillusioned with our healthcare system. When the system fails and patients still need help, they’ll go elsewhere; according to KFF, a third (32%) of adults are turning to AI for health information and advice. And one in six (16%) has used them for mental health information or advice.

A New Way Forward 

It’s possible that we’ve been going about advancing interoperability all wrong. What if we moved toward a model that accepted trust as table stakes while maintaining the guardrails and accountability necessary for a system to operate well? For healthcare data to be trusted and used in care, we have to think about helping it move at the speed of utility, which will in turn deliver the trust to enable the system to operate at scale. 

In a structure that moves at the speed of utility, we don’t give up on requiring trust or all the aspects that ensure that organizations participating in data sharing are upholding the privacy and safety standards inherent to handling patient health information. We create the conditions for entities to exchange information responsibly by requiring secure exchange, verified identity, purpose alignment, consent validation, transparent activity monitoring and governance. 

In this new paradigm, new values and standards would emerge for sharing data. Organizations would prioritize addressing challenges that would help make data sharing easy, precise and useful, favoring this approach over the burdensome “prove that you need it” standard we live in today. That includes accommodating more real-world use cases into TEFCA’s six identified exchange purposes: treatment, payment, public health, benefits determination, healthcare operations and individual access services. 

While treatment is thought of most often, the reality is that for data exchange to solve problems, the lesser-used purposes are just as critical — yet they generally face a higher level of scrutiny and require different types of information. If we were working at the speed of utility, it would be easier for data exchange to solve more problems than patient care. For instance, a pediatrician might choose to share information with a payer proactively to be able to accelerate claims processing instead of all information typically transacted under the “purpose of use” request. 

Exchange of data under a mutually agreed-upon purpose between two trusted organizations, outside traditional regulatory categories, would still be governed by a trust framework. Authentication, valid certificates, consent, reportable and vetting standards don’t change; they just evolve to accommodate more purpose-driven transactions. The outcome is a modernized system of both access and governance that recognizes the value of strong guardrails while enabling the kind of speed that solves real-world problems.

Truly moving the needle in healthcare requires changing the way we do things. Data sharing is key to innovation and building new care models that enable healthier individuals and a healthier America. No system is perfect, but interoperability cannot succeed if utility remains secondary to caution. Data exchange is no longer defined by whether data can move, but by whether it can move responsibly, predictably and at scale. Trust should not be a barrier to participation. It should be the outcome of strong governance, accountability and transparent exchange.