#87. Rethinking Healthcare Interoperability

After a few weeks of holiday, I’m returning to a subject that continues to shape almost every conversation about digital healthcare:

Interoperability

For as long as I can remember, interoperability has been treated as an IT problem. Something for architects, integration teams and standards bodies to solve. Three separate articles this week made the case that this framing is now outdated. Whether the ambition is AI-enabled care, digital front doors, remote monitoring, personalised medicine or care delivered in the home, none of it works without trusted and accessible data. As Rachel Dunscombe argues, interoperability has moved beyond compliance and entered the boardroom because it increasingly determines what kind of healthcare system organisations can become.

That same theme appeared in a new Nature paper from Hanida Abas Tomlinson et al, which highlighted the need for stronger governance, common semantics and a coherent approach to implementation. The authors suggest that England’s challenge is not interoperability itself but “coherent interoperability” across organisations, programmes and technologies. It echoes a lesson many of us have observed firsthand: connecting systems is hard, but aligning organisations is harder.

Spain

Meanwhile, Spain’s Ministry of Health has reached a similar conclusion. Following a national Delphi study involving more than 150 experts, the recommendations for a future national EHR place as much emphasis on governance, semantic interoperability and longitudinal records as they do on technology. Rather than relying solely on traditional system-to-system integrations, the proposed model is built around open, standardised architectures, drawing heavily on principles associated with openEHR and similar approaches. The ambition is to create a shared clinical language and information model that allows data to be consistently understood, reused and analysed regardless of which application originally captured it.

This challenges one of the long-running assumptions in digital health: that organisations can procure major systems independently and then achieve interoperability by exchanging messages between them. The Spanish authors argue that interoperability requires something deeper: separating clinical knowledge from applications themselves and embedding that knowledge in open, standardised models that can evolve independently of vendors.

Epic

The final story comes from Epic. The headlines here are about antitrust investigations, executive departures and questions around AI strategy. But beneath that also sits a debate on how open should healthcare technology ecosystems be.

Epic has long been one of the most successful examples of an integrated platform approach, where much of the capability healthcare organisations need sits within a single ecosystem. However, the increasing importance of AI, the growth of open standards and rising expectations around data portability are putting new emphasis on openness, interoperability and collaboration across vendors. The fact that these questions are now (allegedly) being debated inside the world’s most influential EHR company is an important and interesting signal.

My takeaway from all of these stories is that healthcare’s next wave of transformation will depend on creating the foundations, governance and shared rules that allow information, organisations and people to work together at scale.

The industry has spent years focusing on how data moves between systems. The bigger challenge may be deciding who governs it, how it is understood and how it is used consistently across organisational boundaries.

Originally published on LinkedIn.