Build vs. Buy: Choosing the Right Health Interoperability Engine for Your Organization

July 18, 2025 admin Interoperability

Healthcare organizations today face a crucial decision when implementing a health interoperability engine: Should you build a custom solution in-house or buy a commercial product? An interoperability engine serves as the “power plant” of health data exchange. It supplies the right data to the right systems and people at the right time.

It normalizes data across different standards and systems. For example, converting various HL7, FHIR, DICOM, or API formats. It routes and transforms information between EHRs, labs, HIEs, and other applications. This engine’s central role in enabling healthcare data exchange means the build-vs-buy choice has wide-ranging implications. These implications affect cost, compliance, and capability.

This guide provides a professional, buyer-focused look at both options. We’ll define what interoperability engines do, examine key considerations, discuss when building in-house makes sense versus when buying off-the-shelf is preferable, highlight real-world examples of each, and provide a decision framework to help you make an informed choice.

What Is a Health Interoperability Engine and Why Does It Matter

A health interoperability engine is a software platform that enables different healthcare IT systems to share data and “talk” to each other, despite using different formats or standards.

An interoperability engine handles tasks like message translation, data mapping, and routing, ensuring, for instance, that a lab system’s HL7 lab result message can be received and understood by a hospital’s EHR or another system’s database can ingest that data from one provider’s FHIR API.

As one expert analogy puts it, “integration engines are the power plants that fuel health information exchange” by delivering data where it’s needed for patient care.
Without such an engine, organizations often end up managing a web of brittle point-to-point interfaces between each system.
An interoperability engine centralizes and streamlines the data exchange, handling the variability in standards and implementations so that each system doesn’t have to custom-connect to every other.

This leads to more scalable, maintainable integrations and is critical for initiatives like health information exchanges, enterprise EHR integrations, and any scenario requiring a smooth, secure flow of clinical data.

Related: Healthcare EHR Interoperability in 2025: How to Choose the Right Solution

Key Considerations: Building In-House vs. Buying a Vendor Solution

When deciding whether to build your interoperability engine or purchase a commercial solution, consider the following factors. These will shape which option aligns best with your organization’s needs and capabilities:

Cost (Upfront and Ongoing): Building an engine from scratch demands a significant investment in development and infrastructure.
Speed to Deployment: How quickly do you need interoperability in place? Off-the-shelf engines generally offer much faster implementation. One healthcare provider found that using a pre-built integration engine would allow deployment “within weeks, not months,” whereas developing in-house was projected to take 6–12 months to get a production-ready system.
Maintenance & Support Burden: An often underestimated aspect of building from scratch is the ongoing maintenance. After the initial build, your team is responsible for updates, bug fixes, monitoring, and 24/7 support.
Regulatory Compliance: Healthcare data integration must comply with privacy and interoperability regulations. Any engine handling PHI must be HIPAA-compliant, ensuring data is encrypted in transit and at rest, with access controls and audit logging of who accessed data.
Scalability: Consider the scale of data exchange you need to support and future growth. A homegrown engine gives you control over the architecture, so you can design for scalability.
Vendor Lock-In: Relying on a vendor engine means you are somewhat tied to that vendor’s technology and roadmap. Vendor lock-in can manifest as high switching costs later – your interfaces and data might be structured in proprietary ways, making migration to another platform difficult.
Customization and Feature Fit: One of the strongest arguments for building is the need for highly customized workflows or proprietary system integrations that no off-the-shelf product fully supports.
Internal Technical Capability: Finally, an honest assessment of your team’s expertise and bandwidth is critical. Building an interoperability engine requires specialized knowledge in healthcare data standards (HL7, FHIR, DICOM, etc.), interface design, and security.

With these factors in mind, let’s look at scenarios where building in-house vs. buying makes the most sense.

When Building Your Own Interoperability Engine Makes Sense

Choosing to build an interoperability engine in-house can be advantageous under specific circumstances. Here are use cases and conditions where building is often preferred:

1. Unique or Highly Customized Workflows

If your organization has specific needs that no vendor meets, building may be the only way to get exactly what you want. For instance, you might need to integrate a proprietary internal system or support an uncommon data format that off-the-shelf engines don’t handle well.

Highly specialized hospitals or research-focused institutions often find that custom development aligns the integration tool precisely with their clinical and operational workflows, rather than adapting workflows to a generic tool.

2. Integration with Proprietary or Homegrown Systems

Similarly, if you have homegrown EHR modules or legacy systems with no standard connectors, an internal build allows you to design interfaces around those systems. You can create custom adapters and business rules that a commercial engine might not support.

This was the case at Penn Medicine, where leaders chose to develop certain digital health tools in-house to ensure smooth integration with their existing systems, something an external product might not have achieved as neatly.
Although ~90% of Penn Medicine’s technology solutions are purchased from vendors, they found that certain projects were optimal to build internally due to specific integration and innovation needs.

3. Need for Total Control and Flexibility

Building your engine gives you full control over the product roadmap and features. If long-term control of the integration platform is a priority, for example, you want the ability to rapidly add new features, accommodate future standards, or even commercialize the solution, then building can make sense.

Some healthtech startups opt to build their integration engine as a strategic asset.
Redox deliberately built its engine from the ground up to achieve cloud scalability and faster innovation cycles, enabling it to roll out new capabilities quickly.
This kind of control is impossible with a closed third-party product.

4. Internal Innovation and Competitive Advantage

In-house development can foster a culture of innovation. If your organization values technology as a differentiator, building the engine may align with that mission.

You not only get a tailored product but also develop internal knowledge and intellectual property. In some cases, a custom interoperability solution might even become a competitive advantage or a product in its own right.

5. Adequate In-House Expertise and Resources

You should strongly consider building only if you have the right talent and resources to do it properly. This means experienced healthcare integration engineers, architects who understand scaling and security, and the budget to allocate their time to the project. If these conditions are met, building allows your team to craft a solution exactly suited to your environment.

When Buying a Commercial Interoperability Engine Makes Sense

In many situations, opting to buy or license a commercial interoperability engine is the smarter choice. Consider going with a vendor-provided solution in scenarios like these:

1. Need for Rapid Deployment and Proven Reliability

If time-to-market is critical, a commercial engine can be deployed far more quickly than building one. Healthcare organizations often face urgent needs, for example, connecting to a health information exchange or fulfilling a new regulatory requirement, where a ready-made engine can be stood up in weeks. Buying is also prudent if you want a solution that’s already battle-tested in the field.

Commercial engines have been used by many customers, so their reliability is proven and backed by support SLAs. In a clinical environment where downtime is not acceptable, having a vendor accountable for reliability (often with 99.9% uptime guarantees) provides peace of mind.

2. Limited Engineering Resources or Expertise

Organizations with limited in-house IT capacity should lean towards buying. Smaller hospitals, clinics, or startups may not have integration specialists on staff.

In these cases, a vendor engine not only provides the technology but often training and support services that you would lack if you built your own.
It effectively lets you “buy” the expertise of a team that focuses solely on healthcare interoperability.
This mitigates the risk of mistakes in implementation and frees your internal team to focus on other priorities.

As one checklist suggests, choose buying if you lack internal experts for ongoing support, or if you want to leverage a vendor’s deep domain knowledge and keep up with industry best practices easily.

3. Standard Use Cases with Out-of-the-Box Solutions

Most healthcare organizations face similar connectivity challenges. A commercial interface engine probably handles what you need.

Take ADT messages from your hospital EHR to billing systems. Or exchanging C-CDA documents with other providers. State immunization registry connections also fall into this category. Existing products support these scenarios well.

Building from scratch wastes time and resources. Buying a ready-made solution delivers immediate value. These products include pre-built connectors. They also provide tested mappings. Modern engines offer user-friendly tools. Drag-and-drop interface builders speed up development. Testing environments catch issues early. Monitoring dashboards track performance in real-time.

Creating these features internally takes years. The cost runs high. The risk of delays grows substantial.

Healthcare standards change regularly. Vendors handle updates automatically. Your system stays current without manual intervention. This approach reduces your technical burden significantly.

4. Regulatory Compliance and Security Assurances

If you want to mitigate compliance risk, buying can be a safer route. Reputable interoperability engine vendors design their products to meet healthcare regulations from the ground up, including:

HIPAA security rule compliance
Role-based access controls
Audit logging and
Often certifications like HITRUST or SOC2.

They are also prepared for frameworks like TEFCA, enabling connectivity to national networks when needed. By buying, you essentially get a solution that is already vetted for security and interoperability standards.

For example, a vendor engine might come with built-in VPN, encryption, and logging features to tick all the boxes for HIPAA and audit requirements.
This can greatly reduce the burden on your compliance and security teams compared to building these features internally.

Related: How The CMS 2025 Interoperability Rule Transforms Healthcare Data Access And Compliance

5. Desire to Avoid Maintenance and Focus on Core Business

Many healthcare providers and digital health startups decide that maintaining an integration engine is not their core business. By purchasing a solution, you offload ongoing maintenance, support, and upgrades to the vendor. As Iron Bridge highlights, a subscription engine service can offer 24/7 monitoring, auto-scaling, and regular updates for a monthly fee, sparing you the effort of managing a complex infrastructure and on-call support team.

This frees your internal team to work on projects more directly related to patient care or product innovation rather than “keeping the pipes flowing.”

If your strategic focus is delivering healthcare or building unique patient-facing features, buying an engine allows you to focus on what you do best and let specialists handle the integration plumbing.

A Decision Framework for Build vs. Buy

Making the final decision involves balancing the above considerations against your organization’s situation. Here’s a simple checklist and framework to guide your thinking:

Consider building in-house if:

You have a highly specific integration need or workflow that no existing product adequately supports.
Your organization has strong in-house development expertise in health IT and available engineering capacity to take on a major project. You possess specialized knowledge in healthcare data standards and interface development, and you’re prepared to maintain the solution long-term.
Customization, control, and flexibility are top priorities; you need to tightly align the engine with internal systems, or you want full ownership of the technology.
There is a strategic or regulatory reason to build, for example, to innovate faster than vendors can or to ensure compatibility with a proprietary environment. Also, if compliance or security requirements are so unique that you trust your team over any vendor to meet them, building might be justified.

Consider buying from a vendor if:

Speed to implementation is critical; you need a working interoperability solution quickly to meet business goals or regulatory deadlines.
You have a limited budget or IT resources to allocate upfront. Buying typically has a lower upfront cost and shifts much of the work to the vendor. If your team is small or lacks integration experience, a vendor solution can prevent costly mistakes and project overruns.
Your needs are standard or well-covered by existing products. If an off-the-shelf engine offers 80–90% of the features you require, it’s usually more cost-effective to buy and perhaps do minor customizations, rather than build the entire 100% from scratch.
You want to offload maintenance and leverage vendor expertise. If maintaining an engine infrastructure and keeping up with standards is not something you want your team focused on, buying lets you tap into the vendor’s ongoing innovations and support. This includes staying current with things like new FHIR versions, TEFCA connectivity, and security updates with minimal effort on your part.
Avoiding risk is important. Vendors have done this before; their implementation guides, best practices, and support can significantly reduce the risk of project failure. They also often have user communities and certified consultants, which can be a safety net that you won’t have if you’re on an island with a custom build.

Related: How FHIR Resources and Profiles Power Modern Health Interoperability

Unlock Seamless Interoperability with CapMinds

Choosing between building or buying your health interoperability engine is just the beginning.

At CapMinds, we help you make the right move and then power your success with end-to-end healthcare integration services.

Whether you’re looking to implement a scalable engine or need deep customization, our experts are here to guide and build with you. Our Interoperability Services Include:

HL7 v2 & FHIR Integration Engine Development
Centralized Health Information Exchange Solutions
Custom API Development & EHR Connectivity
TEFCA-Ready & HIPAA-Compliant Data Exchange
Managed Interoperability & Support Services

CapMinds blends deep domain expertise with agile engineering to deliver compliant, future-ready interoperability platforms.

Avoid delays, reduce costs, and gain total control over your health data exchange. Let CapMinds power your interoperability journey. Talk to our experts today.