Global Interoperability Gaps Revealed in 2025 Healthcare Connectivity Rankings
LONDON, UK / / April 24, 2025 / A newly released international research by Black Book ranks the digital interoperability performance of healthcare systems worldwide, spotlighting major disparities in health data exchange capabilities and system integration across 18 high-income countries. The study-based on verified usage data, government platform metrics, and over 2 million stakeholder surveys-highlights Estonia as the global benchmark in EHR connectivity, achieving a 99.1% national interoperability rate.
The study arrives as countries push to modernize healthcare through digital tools that improve patient outcomes. Black Book's multi-year survey data shows that true interoperability leads to better care coordination, faster diagnoses, fewer medical errors, and reduced costs for both patients and systems. In top-ranked countries, providers report stronger continuity of care, improved patient safety, and less duplication of tests, clear evidence that when health data flows freely, patients benefit the most. These systems also support more proactive care, enabling clinicians to identify risks earlier and respond with timely interventions. Ultimately, fully connected health infrastructure gives patients greater control over their health and delivers a more efficient, personalized care experience.
What Is the Interoperability Rate?
Black Book's global interoperability ratings are based on feedback from nearly two million healthcare professionals and stakeholders who participated in surveys between 2020 and 2025. Respondents were asked to evaluate how well their electronic health records or national health data systems shared patient information and supported full, real time connectivity across care settings. Black Book defines the interoperability rate as the percentage of healthcare providers such as hospitals, clinics, pharmacies, laboratories, and general practitioners actively exchanging patient data through standardized digital systems. These ratings are calculated using a combination of reported integration metrics from national health platforms and direct survey responses, offering a comprehensive view of how connected and effective each country's digital health infrastructure really is.
Top-Ranked Countries in Healthcare Interoperability (Q2 2025)
Estonia (99.1%) - Estonia leads globally with near-universal data sharing among providers. Its centralized governance through the Estonian Health Information System (EHIS) and secure, real time exchange via the national X-Road platform allow for seamless clinical coordination, real time access to complete patient records, and high provider satisfaction with system usability and reliability.
Finland (98.9%) - Finland's national Kanta Services platform sets a high standard for digital health integration, backed by mandatory participation, strong regulatory enforcement, and widespread adoption of HL7 FHIR protocols. Survey respondents consistently noted improvements in care quality, timely diagnostics, and reduced duplication of tests as a result of the system's consistent data availability.
Denmark (98.2%) - Denmark's success is rooted in robust national mandates and the Sundhed.dk portal, which enables real time access to unified clinical data across public and private care settings. Providers reported high confidence in system accuracy, ease of use, and support for cross-sector collaboration.
Sweden (95.4%), New Zealand (90.3%), and Singapore (90.1%) - These countries have achieved high interoperability through national strategies that prioritize data standards, patient-centered platforms, and public-private collaboration. New Zealand's Health Information Standards Organisation (HISO) and Singapore's national electronic health record system were specifically highlighted in surveys for their responsiveness and efficiency in clinical workflows.
Netherlands (88.9%) and Norway (87.3%) - Both countries benefit from strong digital health infrastructure and increasing FHIR adoption, though survey data revealed that regional variation and administrative complexity can occasionally impact full data consistency. Norway's central eHealth governance is making progress, but some stakeholders noted slower adoption in rural areas.
Australia (85.7%) - Australia continues to advance through its National Healthcare Interoperability Plan (2023-2028), but faces integration hurdles at the state level. Despite its My Health Record platform, providers surveyed cited uneven digital maturity and variable system engagement across regions as key challenges to achieving full connectivity.
Lower Performing Nations and Interoperability Challenges
United Kingdom (80.5%) - While NHS Digital has driven major interoperability initiatives, disparities between regions and digital system maturity persist. Black Book survey feedback pointed to variable experiences across care organizations, particularly between urban and rural NHS Trusts.
Canada (74.6%) - Canada's interoperability progress is shaped by provincial autonomy and decentralized digital strategies. While the Pan-Canadian Interoperability Roadmap offers national guidance, survey respondents reported inconsistent data-sharing capabilities and gaps in cross-jurisdictional access.
Germany (70.2%) - Germany has invested heavily in digital health through the electronic patient record (ePA) and Medical Informatics Initiative, but complex federal governance and regulatory delays have slowed adoption. Providers in multiple Länder noted limitations in cross-provider record visibility and inconsistent standards implementation.
United States (59.8%) - The U.S. continues to face significant structural challenges. Fragmented EHR systems, voluntary participation in health information exchanges, and inconsistent compliance with federal interoperability rules hinder widespread data sharing. Surveyed providers expressed concerns over administrative burden, limited patient record portability, and insufficient cross-platform compatibility - even within the same state or hospital network.
Vendors Driving Interoperability in Top-Performing Nations
Countries leading in healthcare interoperability - such as Estonia, Finland, Denmark, Sweden, and New Zealand - have advanced far beyond foundational EHR adoption. Their success is powered in part by interoperability-focused technology vendors delivering the infrastructure for real-time, standardized health data exchange.
In Estonia, local firms like Nortal and Helmes have built core national platforms, including the X-Road framework and Estonian Health Information System (EHIS). Finland and Sweden rely heavily on vendors such as Tietoevry and Cambio Healthcare, which offer openEHR and HL7 FHIR-compliant solutions across regional and national care networks.
InterSystems and Orion Health provide enterprise-level interoperability platforms in countries like Denmark, New Zealand, and the Netherlands, supporting unified patient records and population health initiatives. Meanwhile, Graphnet Health and Philips continue to shape data sharing in the UK and continental Europe through advanced care coordination and diagnostic integration platforms.
These vendors offer scalable, vendor-neutral architectures and are instrumental in transforming interoperability from aspiration to reality - laying the digital foundation for connected, patient-centered care.
Estonia: A Case Study in National Digital Infrastructure
The report includes a deep-dive into Estonia's ecosystem, highlighting the country's legal mandate for provider participation, seamless national ID integration, and centralized patient record architecture. In a Q1 2025 Black Book survey of 128 Estonian providers:
96% expressed high satisfaction with overall data-sharing effectiveness.
98% agreed that cross-institutional record access improved care coordination
89% rated the system's usability as excellent and also, 89% believed digital infrastructure investments produced measurable ROI.
The Estonian model demonstrates the power of unified health IT policy, not just product deployment. In countries where interoperability is optional or overly fragmented, the patient experience suffers and clinical decisions are delayed. Estonia is showing what true digital maturity looks like in healthcare.
"Interoperability works best when it's built into the foundation, not added later," said Doug Brown, Founder of Black Book Research. "We're seeing that real progress happens when countries align governance, adopt shared standards like FHIR, and enable transparent, real-time access across systems-without locking providers or patients into closed ecosystems."
Countries like Germany (70.2%), the UK (80.5%), and Canada (74.6%) are making progress through national roadmaps and investments, but continue to face challenges such as provincial fragmentation, legacy systems, and regulatory delays.
About the Report
The 2025 International Interoperability and Health Data Connectivity Rankings is an independent global study developed by Black Book Research. It evaluates comparative EHR utilization, national infrastructure maturity, and real-time health data exchange effectiveness across 18 high-income countries, using both quantitative data and stakeholder sentiment. The 2025 Black Book of Global Healthcare IT is a 600 page resource offered to the industry without charge at https://blackbookmarketresearch.com/register-for-the-black-book-of-global-healthcare-it-2025-report Black Book also offers another complimentary report on global opportunties for openEHR at https://blackbookmarketresearch.com/the-black-book-global-growth-opportunities-for-openEHR-adoption-in-2025-2026
About Black Book Research
Black Book Research is a global market intelligence firm recognized for its independent, vendor-agnostic evaluations in healthcare technology. Since 2004, Black Book has surveyed millions of healthcare professionals, executives, clinicians, and patients to assess software, services, and digital transformation initiatives across the care continuum.
Media Contact:Media Relations, Black Book Researchresearch@blackbookresearch.comwww.blackbookmarketresearch.com8008637590
SOURCE: Black Book Research
View the original press release on ACCESS Newswire
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