A home health agency needs a signed physician order before a visit counts, before billing can proceed, and before a surveyor will call the chart clean. The physician who has to sign it might be a mile away. The practice might even run on the same EHR vendor as the agency. Neither helps. The two systems do not talk, so the order goes out the only way it can, by fax. Someone calls to confirm it arrived. Someone calls again three days later because it did not. Multiply that across the open orders on an active census, every week.

That is what an interoperability failure looks like on the ground: a signature stalled in a fax queue while a clock nobody can see keeps ticking. The keynote version of interoperability is measured in records exchanged and networks connected. The floor-level version is measured in hours on hold, waiting to learn whether a piece of paper made it to a provider’s pen.