Evaluating HALO: A Middleware Approach to Interoperability in Ontario’s Primary Care System

Ontario's primary care system faces challenges from fragmented digital infrastructure, where electronic medical records (EMR) operate in silos. This contributes to administrative inefficiencies, delayed care, and provider burnout. This evaluation examined the feasibility and potential impact of the Health Application Lightweight Protocol (HALO), a vendor-neutral middleware framework designed to enhance interoperability and automate high-volume tasks across disparate EMRs. Data was collected through an online survey of primary care providers and key stakeholder interviews. Findings revealed strong support for HALO's potential to streamline workflows and improve care coordination. HALO met key requirements such as single sign-on, task automation, and middleware integration. However, critical gaps including vendor alignment, governance, and organizational readiness exist. Key recommendations to address these gaps included unified governance, a certified vendor marketplace, and clinical champions networks. HALO offers a scalable pathway to unify Ontario's fragmented primary care digital systems and foster patient-centered innovation. This evaluation provides actionable insights for policymakers and healthcare leaders aiming to advance interoperable health IT integration.