FHIR is not a silver bullet that solves all interoperability problems.
Throwing money at a big FHIR project that exposes or consumes data via FHIR APIs does not mean you can tick the “Interoperability” checkbox.
Here are some examples of how systems using FHIR can look interoperable without truly being interoperable.
1. “FHIR compliant” is not the same as good data
Data can pass FHIR validation and still be incomplete, inconsistent, or misleading.
2. Context can be lost in transmission
Observations recorded without Encounters, intent or circumstances.
3. FHIR validates structure, not plausibility
A perfectly valid 5 year old patient: male, married and pregnant.
4. Coded data can still be bad data
Custom codes when bindings are loose. Text values in place of codes.
5. Bad data can be shared as easily as good data
FHIR enables all data to move efficiently (bad data as well as good data).
When two systems speak to each other using FHIR for the first time, there’s often celebration.
Data is flowing. Everything is working!
But a key part of Interoperability is that data should be usable by other systems.
If another system can read your FHIR data but is unable to confidently use it, then you are NOT interoperable, no matter how valid and compliant your FHIR resources are.
When data flows but meaning doesn’t, interoperability is an illusion.
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