Hospital Systems Rarely Pass Records to Each Other. The Connection Is Usually a Person.
We reviewed the public record on old healthcare systems that cannot exchange records. Here is what we found, what waits while staff carry records by hand, the four ways forward, and the benchmark we would set.
A patient’s blood result is ready at ten past nine. It is on the laboratory system, complete and correct.
At twenty to ten a printed copy reaches the ward. A nurse types the figures into the hospital’s main record system, between two other tasks. At ten the doctor opens the record and sees them.
Later the same test is written on a charge slip, carried to billing and keyed in a third time. Three systems now hold the same result. None of them received it from another.
The paradox: The hospital has a system for every department, and the only thing connecting them is its staff.
What We Found
Before we suggest anything to a hospital group, a laboratory chain or a pharma company, we study its sector. For this article we went through the public record on old healthcare systems and the exchange of records: a US government audit of one very large record system, an Indian medical journal, UK government figures and one staff survey, from 2025 to 2026.
Four findings stand out.
Even very large record systems were built to keep records, not to share them. The US Department of Veterans Affairs relies on a record system that its auditor describes this way: it “has been in operation for more than 30 years, is costly to maintain, and does not optimally support VA’s need to electronically exchange health records with other organizations”. That is a far larger system than our readers run. The sentence still describes many smaller ones: decades old, still working, and unable to share.
Indian hospitals run many different systems side by side. A 2026 article in an Indian medical journal lists, among recurring weaknesses, “heterogeneous hospital information systems” and “limited interoperability between hospital platforms and external digital services”. In plain words: many systems of different ages, which do not easily pass records to each other or to services outside the hospital.
Old technology is common. The UK government’s review records that around 10% to 50% of NHS trusts’ technology is classed as legacy.
Staff feel the cost. In one survey of more than 1,000 frontline healthcare staff in the US, the UK and Ireland, 63% in the US and 36% in the UK said they work with modern systems. Nearly all, 98%, said inefficient technologies are causing patient care and safety issues. The survey was about technology in general, not about exchanging records, and a vendor paid for it.
The record does not say how hospitals move records between systems that cannot exchange them. Our reading is that people do it: they print, carry and type, and the hand-off becomes part of the job.
What our review does not show: The only named case is a very large US government department, not a mid-size hospital. The survey was paid for by a vendor and is about technology in general. We found no public case of a mid-size hospital, diagnostic chain or pharma company that cannot exchange records, and no published figure for the hours spent re-typing, for mistakes made in re-typing or for charges missed. That staff become the connection is our reasoning, not a measured finding.
What Waits While People Carry the Records
Re-typing is usually treated as a small inefficiency. Our reading is that it also holds the organisation in place.
The first cost is invisible. No budget has a line for re-typing. It is paid in minutes, by people hired to do something else, and it is longest when the department is busiest.
The second cost is that the copies drift. Three systems hold three typed versions of one result. When they disagree, nobody knows which is right, and the answer is more checking by the same staff.
The third is what cannot be built. A partner laboratory that wants to send results straight in, an insurer that wants claims electronically, a referring doctor who wants the discharge summary: each needs a record to leave one system and enter another without a person in between. While people are the connection, every new partner adds another hand-off.
The gap we see: most hospitals know that some records are typed twice. Few can say where each hand-off happens, what is carried, by whom and how often, and which one should go first. An organisation that holds that list can plan its connections one at a time. One that does not keeps adding people to the gaps.
This is our reading of the evidence. It is not a measured market figure.
Four Ways Forward, Weighed
There are four real options. Each one is right for somebody.
| Option | When it fits | What it risks |
|---|---|---|
| Keep re-typing, with staff as the connection | Hand-offs are few and low in volume, and no partner is asking for records | The cost stays invisible and grows with every new system and partner. Copies drift apart |
| Build a connection around the old system: a separate program that takes records out of it and passes them on | The old system can already produce a file or a report, its data can be read safely, and it is in good shape otherwise | The connection depends on a system nobody can change. It breaks when the old system changes, and it is one more thing someone must look after |
| Replace the whole hospital information system | The old system is failing in many places, and the organisation is ready for a long programme | Every department changes on one date. The need to share one record waits for the whole programme |
| Write down what the old system does, then rebuild first the module that must exchange records, while the old one keeps running | The system is old, undocumented and used every day, and one or two records must move first | It runs over several stages. For a time two systems run side by side. Reading the system will turn up things nobody can explain |
Our recommendation: start with the hand-offs, not the integration project. Write down where records are carried by hand and what the old system does, then rebuild first the module whose records most need to move, onto technology that can pass them on, while the rest keeps running. We do not sell a connection product, and we do not change a product that belongs to another supplier. While each hand-off waits its turn, your staff go on carrying it.
Where You Are Now, and Where You Should Be
A recommendation is only useful if you can tell later whether it worked. So before any work begins we set a benchmark: a few measures taken from your own systems, each with a target.
For this issue, the benchmark would look like this.
| Measure | Typical starting point | Where it should be | How it is checked |
|---|---|---|---|
| Hand-offs done by people | Not counted; known only to the staff who do them | Each listed: what is carried, from which system to which, by whom and how often | The list, confirmed by the desks that do the work |
| Records re-keyed between systems | The same details typed at several desks | Fewer after every accepted module | Reported at every review |
| What the old system does with each record | Known to a few people | Written down, including where each record is kept | The specification |
| An order for the hand-offs | Whichever desk complains loudest | Ranked by how often each happens and where a mistake matters most | The staged plan |
| Modules able to pass their records on | None | Each module that must exchange records rebuilt and accepted, in order | The traceability matrix and signed acceptance |
The starting points above are what the public record suggests and what we expect to find. In an engagement they are replaced by your own figures, taken in the first review. The targets are what we would work towards with you. They are not results we have already achieved for a healthcare organisation.
How We Work With You
- We listen: a free Reliability Review. A first conversation about the systems, the hand-offs between them, and what is waiting on the answer. You leave with a short written note of what we found. You can start with a conversation about the system; we ask for read-only code access only when the assessment begins.
- We research. We research your sector, the regulator’s position and what the public record says about firms in your situation. This article is an example of that work.
- We read the system and propose: the Legacy System Specification Assessment. It produces a map of the system as it stands, a written specification of what it does, a risk register, a cost comparison between keeping and replacing the system, and a staged plan with a fixed quote. AI does a first pass, our senior engineers review it and trace it to the code, and your own experts confirm it. Code access is read-only and logged, never used for training, and deleted within 30 days of the evaluation ending unless we engage. You get the options and our recommendation.
- If you approve, we build. We replace a system one module at a time while the old one keeps running, starting with the module whose records must move first. We never do a single cutover. Each module has a traceability matrix. The work is billed by milestone, each milestone tied to a module you accept, and you can pause after any accepted module. Where a module touches clinical work, accepting it is your clinicians’ decision.
- We review against the benchmark. Before work starts we set the benchmark. After each module we show you where each measure stands, and the filled-in benchmark is yours at the end.
The Review is free. Every paid step is fixed price, agreed at scoping. Stop after any step. The findings are yours. The assessment fee is credited in full against the first build stage if it starts within 90 days of the report.
We do not work on packaged health record products or medical devices, and we have no published case of this work in healthcare. Your own team or vendor keeps every system running throughout.
What changes for the business:
| Role | What they gain |
|---|---|
| CEO | The organisation stops depending on people as the link between its systems, and their time goes back to patients. |
| CTO or CIO | A written list of every place data is carried by hand, and which hand-off should be dealt with first. |
| CFO | Charges reach billing from where they arise, so fewer are keyed twice or missed. |
| COO | Front desk, laboratory and billing stop re-typing the same details, and hand-off points stop being where queues form. |
| Medical head | Results and notes reach the clinician’s screen from the system that produced them, without waiting to be typed in. |
The cases in this article, and what IOanyT does about that kind of problem:
| The case | What IOanyT does |
|---|---|
| The US Department of Veterans Affairs runs a record system, more than 30 years old, that its auditor says does not optimally support the electronic exchange of health records. | Our part is far smaller than this case, and we do not work on record systems of that kind. For an organisation’s own applications, we write down what the old system does and rebuild the module whose records must move first, one module at a time, with the old system still running. |
IOanyT is a consultancy with its own engineering team: we study the problem, recommend, and prove it by building only what you approve. We start with the hand-offs, because that is where the missing connections show.