In our latest episode of Out of the FHIR, I had a refreshingly candid conversation with Scott Rossignol of Farseen Advisors. With over 15 years in the trenches, including a formative period at Epic, Scott brings a dose of reality to the often-hyped world of FHIR and interoperability.

We didn’t just talk about standards; we talked about strategy, pitfalls, and the hard-earned lessons from building and deploying real-world healthcare applications. If you’re tired of the buzzwords and want to know what it actually takes to succeed, this episode is your guide.

Here are some of the spiciest, most crucial takeaways from our discussion:

Hot Take #1: Stop Building for Interop. Build a Product People Want.

One of the most powerful points Scott made was a fundamental shift in mindset. Too many companies lead with their integration strategy, believing that connecting to data is the product itself. Scott argues this is backwards.

He shared an experience of getting a SMART on FHIR app live in just three days. The secret? It wasn’t just the tech. It was a great product solving a clear problem, with motivated stakeholders who wanted it.

As Scott put it, the goal isn’t just to “do interoperability.” The goal is to “build a product that works and pleases your customers, and improves with integration.” Your interoperability strategy should serve your product, not the other way around. If the core product doesn’t provide value on its own, no amount of data integration will save it.

Hot Take #2: FHIR is a Tool, Not the Whole Toolbox.

For developers diving into health tech, it’s easy to assume FHIR is the one-and-only answer. But as Scott rightly points out, clinical and administrative workflows are far too complex for a single standard to solve everything.

The perfect example? Real-time notifications. Scott explained, “If you need event-based pushes, like a notification for a patient admission, you’re not going to get that from a standard FHIR API. You’ll need to look at other standards like HL7v2 ADT feeds.”

Until FHIR Subscriptions are universally adopted and supported (which is still a ways off), the decades-old HL7v2 standard remains a critical part of the ecosystem. True interoperability experts know how to build a hybrid system, leveraging the best tool for the job whether it’s a modern FHIR query or a classic, event-driven ADT feed.

Hot Take #3: National Networks are Promising, But Don’t Hold Your Breath.

Initiatives like TEFCA and the CMS Aligned networks promise a future where data flows freely across a “network of networks.” The vision is powerful, but Scott provides a necessary reality check on the current state.

While progress is being made behind the scenes, what’s publicly available is often limited. Scott notes that much of the CMS Aligned network’s visibility has been “just a few press releases so far.” The real work of establishing trust, defining mature use cases, and getting participants to exchange meaningful data is a slow, arduous process.

His advice for organizations today? Don’t wait for a national network to solve your problems. Identify your specific data needs and find the most direct path, whether that’s through patient-authorized access, regional HIEs, or direct BAA-gated connections. These networks will become incredibly valuable, but you need a strategy that delivers value in the meantime.

* On Implementation Reality: “You could have the perfect application that works flawlessly in a sandbox, but if the health system has a six-month security review process, your timeline is six months. That’s the reality.”

* On EHR Vendor Differences: “I love that Epic has a great user experience… I love that Cerner provides great write-back capabilities… I love that Athenahealth has a one-click deployment. The fact that I can’t say all those things about one EHR tells you everything you need to know about the challenges of integration.”

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