Interoperability is a care problem, not a standards debate
Interoperability discussions in healthcare often get reduced to a technical argument: HL7 versus FHIR. In practice, this framing misses the real issue. Clinicians do not care which standard is used. They care whether they can see the right information, at the right time, with confidence that it is accurate and current.
The UK’s approach to shared care records offers a useful lens for understanding how HL7 and FHIR can coexist in a pragmatic, architecture-led way. Rather than attempting to replace legacy standards, UK programmes have focused on continuity of care, governance, and clear ownership across organisational boundaries.
Executive summary
- HL7 v2 remains the reliable, event-driven backbone inside provider systems.
- FHIR works best at boundaries: shared care, aggregation, and controlled access.
- Shared care succeeds when ownership, consent, and stewardship are explicit.
- Standards enable interoperability, but governance delivers it.
The continuing role of HL7 inside provider systems
HL7 Version 2 remains the operational backbone of many hospitals and clinical systems. Admissions, discharges, transfers, orders, and results continue to rely on HL7 messaging because it is proven, resilient, and deeply embedded in clinical workflows.
In UK healthcare environments, there has been no large-scale attempt to remove HL7 from core systems. Instead, HL7 is treated as an internal optimisation layer: reliable, event-driven, and well understood by operational teams. This stability is critical in environments where downtime or data inconsistency directly impacts patient safety.
FHIR as the boundary standard for shared care
FHIR was designed for a different purpose. Rather than replacing internal messaging, it excels at exposing structured clinical data across organisational and system boundaries. In shared care architectures, FHIR is typically used at the edge: enabling access, aggregation, and controlled sharing of information from multiple source systems.
UK shared care records commonly use FHIR to support read-only and contributory views across primary care, secondary care, community services, and social care. This allows clinicians to access longitudinal patient context without disrupting the operational systems that manage day-to-day care delivery.
Shared care record patterns seen in the UK
Successful UK shared care initiatives tend to follow a small number of repeatable architectural patterns. These include federated data access models, central patient indexes, and clearly defined consent and data stewardship arrangements.
Rather than building a single monolithic data store, many programmes maintain data within source systems and expose it through standardised interfaces. This reduces duplication, supports data ownership, and simplifies change management as clinical systems evolve.
Common interoperability mistakes
Experience from the UK highlights several recurring pitfalls. These include treating FHIR as a database rather than an interface, over-centralising clinical data without clear governance, and assuming that standards alone solve organisational and accountability challenges.
Interoperability succeeds when there is clear ownership of integration architecture, agreed responsibilities between organisations, and an understanding that standards are enablers rather than solutions in themselves.
What NZ healthcare can learn
New Zealand faces many of the same challenges as the UK: a public health system, diverse clinical settings, and increasing demand for cross-provider visibility. The UK experience demonstrates that coexistence between HL7 and FHIR is not a compromise, but a strength when applied deliberately.
By adopting an architecture-led approach that respects existing systems while enabling shared care capabilities, NZ healthcare organisations can improve interoperability without introducing unnecessary risk or complexity.
The JTX IT perspective
At JTX IT, we approach healthcare integration as an architectural discipline. We work with HL7, FHIR, and related standards not as competing technologies, but as complementary tools within a coherent interoperability strategy.
Our focus is on clarity of ownership, sustainable integration patterns, and solutions that support clinical care rather than disrupt it.
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