Why healthcare interoperability fails (and how FHIR fixes it)

Care is rarely delivered by one person, in one system, at one moment. Yet we still build our digital infrastructure as though it is. Patients pay the price, and so do the clinicians trying to help them.

A 78-year-old patient’s end-of-life wishes, documented with her GP, are invisible when an ambulance arrives in the middle of the night. A heart failure patient monitored at home every day is an unknown entity the moment he walks into a different hospital.

The same problem, a different face every time

Advance Care Planning (ACP) and telemonitoring are two use cases that are rightly receiving a great deal of attention. But they are far from the only places where this problem shows up.

Take the 78-year-old patient who worked carefully with her GP to document her end-of-life wishes. No resuscitation. No hospital admission unless truly necessary. When an ambulance is called in the middle of the night, the out-of-hours clinician has no access to that record. What happens next is the opposite of what the patient wanted.

Or the heart failure patient who monitors blood pressure and weight at home every day. The cardiology nurse follows the trends and intervenes early. But his GP, who knows him best, sees none of that data. And if he is referred to a different hospital, everything starts from scratch.

Consider medication management for a patient with five chronic conditions who sees five specialists: the cardiologist prescribes, the internist prescribes, the GP prescribes. Nobody has the full picture. Or take mental healthcare, where a patient navigates between their GP, a mental health institution, community nursing, and a crisis team, four organizations each holding a fragment of the story, rarely the whole.

Why closed systems structurally fail at network care

Most healthcare technology is built for one-to-one connections: one app connects to one care provider, one platform delivers data to one institution. For isolated processes, that works fine.

But the moment care spreads across multiple organizations, as it almost always does in these use cases, the model breaks. Point-to-point integrations are expensive, fragile, and scalable to exactly one combination. Add a new party to the network and you start over.

The only structural solution is to agree on how data looks and how it is exchanged, regardless of which system sends or receives it. Not as a one-off project, but as shared infrastructure.

That is precisely what open standards do: they define a common language that every participant in a network can speak. Without that shared language, every integration is bespoke. With it, collaboration becomes the default, and bespoke the exception.

Why FHIR is the answer for interoperable healthcare networks

If you take open standards as your starting point for healthcare data exchange, you will find yourself at FHIR. Not because there are no alternatives, openEHR is strong for clinical data modelling and storage, and HL7 v2 remains widely used in laboratory and hospital environments.

But FHIR is the only standard that combines broad real-world adoption, active ongoing development, and specific design for exchange across organizational boundaries at the scale that network care requires. No comparable standard offers all three.

Let’s look at advance care planning as an example. In practice, this means a treatment wish is recorded once as a standardized FHIR resource and understood by every connected system. The GP’s system, the hospital EPD, the out-of-hours platform. No fax, no phone call, no paper directive in a drawer. The information is there when it is needed.

In telemonitoring, FHIR enables measurement data like blood pressure, weight, oxygen saturation, to be available as standardized observations to every care provider in the network, not just the platform vendor’s own portal. That is not a technical detail: it is the difference between monitoring as a silo and monitoring as a shared care process.

The same logic applies to medication management and mental health. FHIR enables medication overviews to be synchronized across organizational boundaries, and a mental health treatment plan to be readable by the community nurse arriving that evening. Not through custom integration, but because all systems speak the same language.

EHDS: Europe is moving in the same direction

The European Health Data Space (EHDS), the EU regulation that mandates cross-border exchange of health data, came into effect in 2025. The first obligations take effect in 2029 for patient summaries and ePrescriptions; broader data categories follow in 2031.

FHIR is not explicitly mandated in the regulation itself, but the direction of travel is unambiguous. HL7 Europe published FHIR Implementation Guides in 2025 specifically designed to meet EHDS requirements. The European Commission is building the mandatory exchange format on an unmistakably FHIR-based foundation.

Building on FHIR today does not mean anticipating European legislation, it means aligning with the direction Europe has already chosen.

Less administrative burden, more time for care

Behind every data exchange problem is a clinician losing time. The nurse calling around to find information that exists somewhere in a system. The specialist reconstructing a medical history from what the patient can remember. The GP who does not know which medication was changed during a hospital admission.

Open standards like FHIR do not solve this overnight. Implementation takes investment, and not every system is ready. But they lay the only foundation on which network care can structurally work.

For the clinician, that means less searching and more doing. For the patient, it means that the care planned for them is actually delivered, and that they can access their own health records whenever and wherever they need them.

And for healthcare organizations, it means not just meeting regulatory requirements like EHDS, but delivering better care, improving patient experience, and reducing the administrative overhead that drains clinical capacity.

Not eventually, but now.

I genuinely believe that we are building the infrastructure for the future of healthcare. Every standard implemented, every connection made, every patient record that reaches the right clinician at the right moment, it adds up to something that matters. That belief is what makes me proud to lead Firely every single day.

If you want to discuss how FHIR can work for your organization, feel free to reach out.