What Is the Last Mile of Interoperability—and Why It Matters Now More Than Ever

Laura Young
Jul 17
4 min read

As the healthcare industry continues to push toward seamless data exchange, the concept of the "Last Mile of Interoperability" has emerged as a critical frontier. While hospitals, labs, and clinics have made tremendous progress in connecting and exchanging clinical data, many of the most important touchpoints that shape health outcomes still sit outside these traditional systems. These gaps—found in behavioral health, social care, maternal and reproductive health, emergency medical services (EMS), and justice-involved care—are where the last mile begins.

Defining the Last Mile of Interoperability

The "last mile" in any network refers to the final leg of a system that connects end users to the broader infrastructure. In healthcare interoperability, this means integrating systems and data sources that have traditionally been left out of HIE frameworks—despite playing a crucial role in health outcomes.

This includes:

Behavioral Health: Mental health and substance use treatment data, often governed by special privacy protections such as 42 CFR Part 2.
Social Care Data: Information from community-based organizations (CBOs), housing and food assistance programs, transportation services, and case management systems.
Maternal and Reproductive Health: Data from prenatal care programs, family planning clinics, public health departments, and midwives or doulas.
Emergency Medical Services (EMS): Pre-hospital data from paramedics and first responders, essential for real-time clinical decision-making.
Justice-Involved Data: Health data from correctional facilities, reentry programs, and parole or probation services—critical for ensuring continuity of care during transitions into and out of incarceration.
Other Care Settings: School-based health centers, tribal health services, mobile clinics, and shelters.

These non-traditional data sources hold essential information for delivering whole-person care. Yet they often remain siloed due to legal complexity, technical barriers, or lack of infrastructure.

Why HIEs Must Focus on the Last Mile

For Health Information Exchanges (HIEs), expanding into the last mile is not just a strategic growth opportunity—it is a mission imperative. Here’s why:

Health Equity: Individuals who rely on behavioral health, social care, or justice-involved services often face systemic barriers to care. Integrating these data helps address disparities and coordinate resources more effectively.
Better Outcomes & Crisis Response: Access to data from EMS, social services, or correctional health can prevent gaps in care, reduce unnecessary hospitalizations, and improve patient outcomes.
Provider Efficiency: Frontline providers—especially in primary care, behavioral health, and emergency settings—need timely, complete information to deliver safe and coordinated care.
Policy & Funding Alignment: National and state initiatives like CalAIM, TEFCA, and CMS payment reform all support cross-sector data exchange as foundational to value-based care.

Enhancing HIE Sustainability and Value

Adding last mile data sources doesn’t just improve care delivery—it directly supports long-term sustainability for HIEs:

Increased Value Proposition: Integrating behavioral health, social care, EMS, and justice-involved data makes the HIE more valuable to users—offering a more comprehensive picture of patient needs and service utilization.
New Revenue Streams: These sectors represent new partnership and funding opportunities. HIEs can support correctional health transitions, social care referrals, or behavioral health integration efforts—often backed by Medicaid, grants, or public health contracts.
Stronger Policy Alignment: As public agencies seek to meet new data-sharing requirements and improve service coordination, HIEs that offer last mile capabilities are better positioned to win contracts and play a lead role in state and regional initiatives.

How HIEs Can Get Started

Getting started with last mile integration requires a thoughtful, phased approach:

Define Clear Use Cases: Focus on specific, high-impact problems like reducing ED visits among justice-involved individuals or closing maternal health gaps for Medicaid members.
Build a Cross-Sector Advisory Group: Include stakeholders from behavioral health, CBOs, EMS, correctional health, public health, and others. Co-design governance, data-sharing agreements, and workflows.
Navigate Consent and Legal Challenges: Address specific requirements for sensitive data, such as 42 CFR Part 2 or HIPAA considerations for social and justice-involved data.
Assess Technical Infrastructure: Determine data types, frequency, and method of exchange (e.g., FHIR APIs, HL7 feeds, or closed-loop platforms).
Pilot and Scale: Start with a limited implementation, gather metrics, and use early success to expand and attract additional partners or funding.
Educate and Communicate: Ensure providers and patients understand the purpose, protections, and benefits of expanded data sharing.

The Impact on Patients and Providers

When HIEs connect the last mile, the impacts are profound:

Patients experience smoother transitions of care, less fragmented services, and care that reflects the full context of their lives.
Providers receive timely, complete information, enabling better clinical decisions and reducing administrative burdens.
Communities benefit from data-driven policy, targeted interventions, and smarter resource allocation.

Final Thoughts

The last mile of interoperability is not a luxury—it’s a necessity. It is where fragmented systems meet the promise of whole-person care. For HIEs, expanding into behavioral health, social care, EMS, maternal health, and justice-involved data is both a moral imperative and a smart business move. The organizations that take bold steps toward last mile integration will not only improve care but secure their own future as indispensable health data infrastructure.

Ready to Bridge the Last Mile?

If your HIE is ready to expand its impact, improve whole-person care, and unlock new value through behavioral health, social care, EMS, justice-involved, and maternal health data—now is the time.

Let’s work together to turn policy into practice, and data into better care. The Last Mile of Interoperability is what Converge Health does best.