Is Interoperability an Economics Problem? Early Lessons from e-Prescribing

Healthcare systems have invested heavily in interoperability, yet adoption by clinicians has been inconsistent. Despite the availability of mature technical standards, many providers continue to rely on fax and other low-tech methods for information exchange. This paper explores whether the barriers to adoption are primarily technical or economic in nature. Using e-prescribing as a comparative case, we examine three jurisdictions that adopted similar technologies but experienced very different outcomes: Canada, the United States, and Denmark. Canada pursued a voluntary model and saw limited uptake. The United States initially struggled but achieved significant adoption once penalties were tied to Medicare Part D. Denmark achieved near-universal adoption by mandating use nationwide. These contrasting outcomes suggest that interoperability adoption hinges on how costs and benefits are distributed among stakeholders, rather than on technology alone. Drawing on economic theories of transaction costs, externalities, Coase's theorem, and information asymmetry, we offer an early framework for interpreting adoption outcomes. While our analysis is limited to e-prescribing and related cases, the findings suggest that economic design principles may be critical for sustainable interoperability. Future work should extend this framework to other domains of health data exchange.