Interoperability Performance and Vendor Readiness Across U.S., Europe, Canada, APAC, and the Middle East

NEW YORK, NY / ACCESS Newswire / September 22, 2025 / Black Book Research today announced the release of its 2025 Middleware Mandate Report, a comprehensive 90-page study capturing the pivotal role of middleware in healthcare's evolving data economy. For the first time, healthcare stakeholders have access to a comparative benchmarking of interoperability vendors across the U.S., Europe, Canada, APAC, and the Middle East, evaluating readiness under TEFCA (Trusted Exchange Framework and Common Agreement) and EHDS (European Health Data Space).

The report is based on 2,484 validated survey responses from hospital executives, payers, physicians, compliance leaders, and national health system authorities. Results confirm that middleware: APIs, repositories, gateways, and interoperability platforms, has emerged as the strategic control plane for compliance, ROI, and AI readiness.

Key Highlights from the 90 Page Gratis Industry Report

Middleware emerges as top IT spend in 2025: 72% of organizations expanding interoperability cite middleware as their largest new IT investment, surpassing EHRs.

TEFCA adoption accelerates: 44% of U.S. buyers are actively onboarding with Qualified Health Information Networks (QHINs).

EHDS drives Europe: 71% of EU stakeholders identify EHDS compliance as their top purchasing requirement for 2026.

ROI timelines vary: APAC health systems are realizing middleware ROI in a median of 16 months, while Gulf state health systems lag behind at 23 months.

Speed predicts ROI: Vendors with onboarding speed of 8 weeks or less demonstrate a 2.3× greater likelihood of ROI within 18 months.

Comparative Rankings & Vendor Archetypes

The report benchmarks 53 middleware and interoperability vendors across global and regional performance. Differentiators include:

Speed Leaders (Redox, Smile Digital Health) - rapid onboarding, ROI under 12 months

Compliance Anchors (Health Gorilla, InterSystems, Dedalus) - strong regulatory credibility for TEFCA/EHDS

Legacy Bridges (Lyniate, Intersystems) - essential for HL7v2 environments yet lagging on FHIR maturity

Global Cloud Backbones (Microsoft, AWS, Google) - scalability and analytics with challenges in sovereignty and cost predictability

Who Should Access the Report

The Black Book Middleware Mandate is a resource for hospital and health system executives, CIOs, CMIOs, compliance leaders, national program officials, policymakers, and investors navigating healthcare's interoperability strategies.

About Black Book Research

Black Book Research, founded in 2011, is the leading independent benchmarking source for healthcare IT. With more than 3.5 million technology users surveyed across 18 KPIs, Black Book delivers unbiased performance data on vendors, services, and digital infrastructure to help providers, payers, and investors strengthen healthcare through smarter, safer technology choices.

The 2025 Black Book Middleware Mandate Report is available now free of charge to industry stakeholders at https://blackbookmarketresearch.com/the-2025-black-book-report-of-the-middleware-mandate

Additionally, a library of over twenty 2025 industry deep dive reports is available gratis at https://www.blackbookmarketresearch.com or contact research@blackbookmarketresearch.com

Contact Information

SOURCE: Black Book Research