Parrish, Roan2025-08-072025-08-072025-06-27https://hdl.handle.net/10919/137095This case study explores the nuances of transitioning to interoperable electronic health record (EHR) systems in the U.S. health care setting, with attention to a hypothetical hospital's change from a homegrown EHR to a commercial TEFCA-aligned system. With reference to the HITECH Act and the 21st Century Cures Act, it highlights policy-driven rationales for interoperability, problems of data migration, and technology and social labor around these transitions. From the experience of Dr. George Foreman and programmer Sylvia Char, the case unravels vendor lock-in, regulatory mandates, and tensions between market incentives and patient needs. It also looks at how interoperability influences not just clinical workflows but also patient access, cybersecurity, and medical research. The case encourages critical consideration of who stands to gain from data portability, how to put the patient at the forefront of digital transformation, and what a democratic model of health data governance could mean.9 pagesapplication/pdfenIn Copyright (InC)This Item is protected by copyright and/or related rights. Some uses of this Item may be deemed fair and permitted by law even without permission from the rights holder(s). For other uses you need to obtain permission from the rights holder(s).United StatesElectronic Health RecordsInteroperability PolicyReportVirginia Tech