A patient needs a ride to dialysis three times a week. The nephrologist's office schedules the appointments. The Medicaid broker authorizes the transportation. The NEMT provider dispatches the vehicle. Three systems, three organizations, zero integration.
Why spreadsheets persist
Every healthcare stakeholder has digitized their own workflow. EHRs handle clinical scheduling. Medicaid management systems handle authorization. NEMT dispatch handles vehicle routing. But the handoffs between these systems are still manual - phone calls, faxes, and CSV exports pasted into spreadsheets.
The FHIR promise and reality
HL7 FHIR was supposed to solve healthcare interoperability. It has made real progress for clinical data exchange. But transportation scheduling sits at the edge of the healthcare data ecosystem. FHIR resources for appointments and encounters exist, but standardized transportation request formats are still emerging.
The rideshare disruption that wasn't
Uber Health and Lyft launched NEMT services expecting to disrupt the industry. They work well for ambulatory patients with simple needs. But wheelchair-accessible vehicles, stretcher transport, attendant requirements, and Medicaid billing complexity mean that 60% of NEMT trips cannot be served by rideshare platforms.
Building the bridge
The solution is not one system to rule them all. It is an integration layer that translates between existing systems: accepting trip requests from EHR scheduling APIs, validating authorization with Medicaid brokers, dispatching to NEMT providers, and feeding confirmation back to the clinical record.
This is a systems integration problem that requires understanding both healthcare workflows and transportation operations. The organizations that solve it will not sell software - they will build the connective tissue that the industry is missing.