Why certification, interoperability and the infrastructure beneath the EHR matter as clinical and financial workflows converge

By Brijraj Bhuptani, Cofounder & CEO, SPRY

A few weeks ago, I was on a call with a large healthcare organization evaluating SPRY.

We were deep in implementation details: patient identity, data migration, authorizations, go-live timing, and how information would move between SPRY and their enterprise EHR.

At one point, their team confirmed that SPRY was ONC Health IT Certified.

“That’s huge for us,” one of their leaders said.

The reaction wasn’t surprising. At their scale, certification, interoperability, security and MIPS requirements are already part of the buying process.

What was more interesting was where the conversation went next.

What happens when an interface fails? Can we see it? Who gets notified? What happens when records don’t reconcile? How does centralized billing get what it needs without opening clinical access too broadly?

Those questions say more about where healthcare software buying is going than the certification question itself.

“Are you certified?” is a baseline question. The harder question is whether the infrastructure can actually carry the business.

The EHR already sits inside the economics of the practice

Outpatient rehab buying conversations naturally start with documentation, scheduling, billing, reporting and cost.

But look at how much of the business now runs through the same technology: patient identity, referrals, coverage, authorizations, documentation, quality reporting, claims and payment.

The boundaries between clinical, administrative and financial systems are getting harder to separate.

MIPS makes that connection concrete.

For clinicians required to report Promoting Interoperability, the category accounts for 25% of the final MIPS score. Certified EHR Technology is required, and applicable measures must be reported using CEHRT for at least 180 consecutive days during the performance year. That performance can affect Medicare Part B reimbursement two years later.

Certification does not automatically improve reimbursement or guarantee a strong MIPS score. And not every therapist or practice is required to report Promoting Interoperability.

But for organizations in scope, certified EHR technology is part of the reimbursement infrastructure.

That does not make certification the differentiation. It makes certification part of the foundation.

Interoperability has a P&L

Healthcare has been talking about interoperability for a long time. The more useful question is what happens when information does not move.

A referral arrives without the right information. Someone enters insurance information again. An authorization exists, but scheduling cannot see it. Something in the clinical workflow fails to make it downstream. A billing exception surfaces later, and someone works backwards to find where the information stopped moving.

At that point, this is no longer an IT abstraction.

It is labor. Rework. Delayed cash. Sometimes a denial.

When data stops moving, someone becomes the bridge. And the bridge is usually a person on your staff.

The ONC certification program gives organizations a verifiable standard for defined health IT capabilities, including interoperability and standardized API access.

But certification does not promise every integration will work perfectly or make every claim clean. The business still has to ask what happens on top of that standard.

Can information move through the workflows that matter? Can failures be detected? Can exceptions be traced without three teams reconstructing what happened?

Prior authorization shows where this is going. Beginning in 2027, impacted payers face new API requirements spanning provider access, payer-to-payer exchange and prior authorization. CMS is also bringing electronic prior authorization into Promoting Interoperability, with the measure optional for bonus points in 2027 and mandatory beginning in 2028. 

The direction is clear: clinical information, coverage, authorization and payment are becoming increasingly connected through the same infrastructure.

The line between “clinical software” and “financial infrastructure” keeps getting thinner.

For larger organizations, this also matters in referral networks, payer relationships and value-based care, where the ability to exchange information across the broader healthcare ecosystem is increasingly part of the operating model.

More capable software raises the bar underneath it

This becomes even more important as software starts doing more of the work itself.

The best software may increasingly be software people operate less because more routine work simply gets done.

Healthcare has an important catch: before software can fade into the background, it has to earn the right to act there.

A system preparing documentation needs the right clinical context. A system working an authorization needs the patient, the requirement and the state of the workflow. A system validating a claim needs context from upstream. When something falls outside the rule, it needs to know when to stop and bring a person back in.

That requires reliable data, workflow state, permissions, auditability, interoperability and exception handling.

These are not always the capabilities buyers notice first.

But they determine whether software can become infrastructure.

Compliance-ready and outcomes-relevant are becoming one buying decision

Last year, I wrote that healthcare technology buyers would increasingly demand two things:

Compliance-ready and outcomes-relevant.

They are often treated as separate tests. In practice, they are becoming one buying decision.

A system that clears a compliance review but creates enormous administrative work is not enough. A system that promises ROI but cannot survive an enterprise security or interoperability review is not enough. A beautiful workflow that traps information inside itself is not enough. And a certification badge with no relationship to how the practice actually operates is not enough either.

The best infrastructure has to do both: stand up to scrutiny and make the business work better.

That is how we think about ONC certification at SPRY.

Not as the product story. Not as a badge that should differentiate a modern EHR by itself.

Certification is a baseline. What gets built on top of that baseline is where the differentiation begins.

Can information move without staff constantly recreating it? Can the team see when something breaks? Can the platform support the regulatory and financial requirements that matter? Can it prevent problems upstream instead of simply helping people work them downstream?

And over time, can software take responsibility for more routine work without asking the organization to give up visibility, judgment or control?

The EHR has been part of the economics of the practice for a long time.

What is changing is how much of the practice we are asking it to carry.

That infrastructure has to stand up to scrutiny and deliver an outcome.

‍