Looking beyond technical standards to make health and care data work together

By Adam Hatherly, Chief Architect, Graphnet Health

Every NHS leader shares the same ambition: ensuring clinicians can access the right information at the right time, wherever a patient receives care. Whether someone attends an emergency department while away from home, is referred between organisations or receives support from multiple services across a complex care pathway, information should follow the patient rather than the organisation. That ambition sits behind many of today's discussions about interoperability, the Single Patient Record and the future of NHS data.

FHIR has become one of the defining technologies within those conversations, and rightly so. As the internationally recognised standard for exchanging healthcare information, it provides an essential foundation for more connected care. However, there is a growing tendency to treat interoperability and FHIR as though they are one and the same. They are not. FHIR is a vital building block, but interoperability depends on far more than a single technical standard.

Speaking the same language isn't enough

One of FHIR's greatest strengths is its flexibility. It has been designed to work across different healthcare systems, countries and clinical settings, giving organisations a common framework for exchanging information. That flexibility has helped make it the global standard for healthcare interoperability, but it also creates an important challenge.

Think of FHIR as agreeing to communicate in English. Two people may both speak the language fluently, but if they use different terminology, interpret words differently or structure information in different ways, misunderstandings are still inevitable. The same is true for healthcare data. Two suppliers may both comply fully with the FHIR standard while representing information differently enough to create additional work for anyone trying to exchange it.

Interoperability therefore requires more than technical compliance. It requires consistency. Clinicians need confidence that when they view a patient's allergies, medications or test results, that information means the same thing regardless of where it originated. Achieving that consistency depends not only on adopting standards, but on implementing them in the same way across the NHS.

This is why the work undertaken through UK Core FHIR is so important. NHS England has invested significant effort in developing implementation guidance that creates greater consistency for suppliers and NHS organisations alike. Rather than continually creating new frameworks, the priority should now be to build on that work, refine it through practical experience and encourage consistent adoption across the health and care system.

Interoperability is about meaning, not just messaging

Exchanging information is only valuable if the receiving system understands what it has been given. Healthcare depends on everyone describing clinical concepts consistently, whether that is a diagnosis, a medication, a blood pressure reading or an allergy.

The NHS has made significant progress through standards such as SNOMED CT, but variation still exists in how information is recorded across organisations. Reducing that variation will be just as important as continuing to develop technical standards. Systems must not only exchange information successfully; they must interpret that information consistently enough to support safe clinical decision-making.

This is where discussions about interoperability can become overly simplistic. Success should not be measured by whether data moves from one system to another. It should be measured by whether that information remains clinically meaningful when it arrives.

Technology is only part of the picture

Technology understandably attracts much of the attention in discussions about interoperability, yet the greatest challenges are often organisational rather than technical.

Shared care records have taken years to develop, not because connecting systems is impossible, but because organisations have invested time building trust, establishing governance frameworks, agreeing information sharing arrangements and developing audit processes that allow information to be shared safely. Those foundations are every bit as important as the technology itself.

As interoperability expands across regional boundaries, there is an opportunity to introduce greater consistency into these governance arrangements. The legal basis for sharing information to support direct care already exists. The next step is reducing unnecessary variation so organisations are not repeatedly solving the same governance challenges in different ways. A more consistent national approach would reduce complexity while supporting wider interoperability across England.

Finding information matters just as much as sharing it

Another aspect of interoperability that often receives less attention is helping clinicians identify where information exists in the first place.

Patients receive care from multiple organisations throughout their lives. Important information may sit within GP practices, hospitals, community providers or mental health services, often across different regions. Before a clinician can access that information, they first need to know where it is held.

National services such as the National Record Locator have an increasingly important role to play. Rather than creating another central repository, the National Record Locator helps authorised professionals identify where relevant information already exists, allowing them to retrieve it securely when needed. Combined with the NHS number, national identity services such as CIS2 and common interoperability standards, these capabilities provide many of the building blocks needed for a more connected patient record while preserving the investments already made across regional shared care records.

The objective should never be to move information simply because it is technically possible. The objective is to ensure clinicians can locate the information they need quickly, securely and at the point of care.

Building on strong foundations

One of the biggest misconceptions surrounding interoperability is the idea that the NHS must begin again to deliver more connected care. In reality, England already possesses many of the capabilities needed to move forward.

Shared care records, population health platforms, national standards, governance frameworks and identity services have all been developed over many years through collaboration between NHS organisations and technology suppliers. They represent substantial investment, practical experience and lessons learned from delivering interoperability in real clinical settings.

The next phase should focus on strengthening those foundations rather than replacing them. That means continuing to improve standards, increasing consistency in implementation, expanding the adoption of national services and focusing on the clinical scenarios where better information sharing will have the greatest impact for patients and staff.

Interoperability in practice

These principles are already beginning to move beyond theory and into everyday clinical practice.

One recent example comes from Integrated Care Northamptonshire, where ReSPECT plans and Electronic Palliative Care Coordination System (EPaCCS) records are now being made discoverable through the NHS National Record Locator. Rather than creating another central repository of patient information, the service enables authorised clinicians to identify where important care planning information is held and access it securely when it is needed.

The impact is particularly significant in urgent and emergency care. If a patient receives treatment away from the team normally responsible for their care, clinicians may be able to access previously agreed treatment recommendations, care preferences and end-of-life wishes without patients or families having to repeat difficult conversations during already stressful situations. It is a practical example of interoperability delivering what matters most: ensuring the right information is available to the right clinician at the right time.

Ultimately, interoperability has never been about technology for its own sake. Success will not be measured by the number of systems connected or the volume of data exchanged, but by whether clinicians can make better-informed decisions, patients receive safer and more coordinated care, and the NHS continues to build on the substantial progress already made. FHIR is an essential building block, but true interoperability depends on standards, governance, terminology, identity and trust working together. The foundations are already in place. The next step is to continue building on them.

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