Interoperability was the pipe. The value is the data that flows through it, joined to the public knowledge the country already built, carried in a common language back to the UMLS, and reasoned over at the bedside. Seventeen pages, every number sourced, free.
In 2013 the West Health Institute put the value of medical device interoperability above $30 billion a year. Real then, real now. But it measured the pipe. The larger prize is what moves through the pipe once it exists, and in critical care that prize is almost entirely unclaimed. The paper works two ordinary bedside cases, a high-alert anticoagulant on a pump and a titratable vasoactive drip, in the current state and the future state, and shows that in both the plumbing did its job and the value was still left on the table.
It is the companion argument to the book The Technology Was Never the Problem, and the reasoning layer it describes is the one running on this site.
Cite as: Pettus DC. The Plumbing Was Never the Point: interoperability, data, and the unclaimed value in critical-care therapy management. White paper, September 2026. DOI: 10.5281/zenodo.22710022.
Daniel Pettus spent forty years in medical device and health IT leadership at Alaris, CareFusion and BD, contributed to IHE Patient Care Device interoperability standards, and is named on two United States patents. He writes Inside the Loop at insidetheloopdp.substack.com and is the author of The Technology Was Never the Problem, at pettusbook.com.
AI MedAgent is a research demonstration of a patent-pending method. Advisory only. Not a medical device. Not for clinical use. Synthetic data only.