Why Interoperability Is Hard

  • Tim Benson
  • Grahame Grieve
Part of the Health Information Technology Standards book series (HITS)


This chapter explores some of the reasons why healthcare interoperability is hard and why standards are needed. Interoperability can be looked at as layers (technology, data, human and institutional) involving different types of interoperability, technical, semantic, process and clinical. Standards are needed to tame the combinatorial explosion of the number of links required to join up systems, but usually require translation to and from an interchange language. Users and vendors are not always incentivised to interoperate. Apparently simple things such as addresses are more complex than they seem. Clinical information in EHRs is inherently complex, but complexity and ambiguity in specifications creates errors. Any interoperability project involves change management.


Interoperability definition Interoperability layers Technical interoperability Semantic interoperability Process interoperability Clinical interoperability Interoperability standards Combinatorial explosion Electronic health records (EHR) Translation Rosetta Stone Problem-oriented medical records (POMR) ISO 13606 Name Address Discharge summary Clinical laboratory reports GP2GP Complexity Errors Change management 


  1. 1.
    Palfrey J, Gasser U. Interop: the promise and perils of highly interconnected systems. New York: Basic Books; 2012.Google Scholar
  2. 2.
    HIMSS. HIMSS dictionary of healthcare information technology terms acronyms and organizations. Chicago: HIMSS; 2006.Google Scholar
  3. 3.
    IEEE. IEEE standard computer dictionary: a compilation of IEEE standard computer glossaries. New York: Institute of Electrical and Electronics Engineers; 1990.Google Scholar
  4. 4.
    Gibbons P et al. Coming to terms: scoping interoperability in healthcare. Final. HL7 EHR Interoperability Work Group, February 2007.Google Scholar
  5. 5.
    Shannon C. A mathematical theory of communication. The Bell Syst Technical J 1946; 27: 379–423 and 623–56.Google Scholar
  6. 6.
    Dolin R, Alschuler L. Approaching semantic interoperability in health level seven. JAMIA. 2011;18:99–103.PubMedGoogle Scholar
  7. 7.
    Grieve G. Dynamic health IT. Blog 2 Dec 2015
  8. 8.
    Hardin G. The tragedy of the commons. Science. 1968;162(3859):1243–8.CrossRefGoogle Scholar
  9. 9.
    Anthony J. Personal communication 2008.Google Scholar
  10. 10.
    Rector A, Nowlan W, Kay S. Foundations for an electronic medical record. Methods Inf Med. 1991;30:179–86.CrossRefGoogle Scholar
  11. 11.
    Health Informatics – Electronic health record communication – Part 1: Reference Model ISO 13606–1:2008.Google Scholar
  12. 12.
    Kalra D. Electronic health record standards. Year Book Med Inform, IMIA 2006; 45:136–44.CrossRefGoogle Scholar
  13. 13.
    Weed L. Medical records that guide and teach. NEJM. 1968; 278: 593–9 and 652–7.CrossRefGoogle Scholar
  14. 14.
    Schultz J. A history of the PROMIS technology: an effective human interface. In: Goldberg A, editor. A history of personal workstations. Reading: Addison Wesley; 1988.Google Scholar
  15. 15.
    Weed LL. Knowledge coupling: new premises and new tools for medical care and education. New York: Springer; 1991.CrossRefGoogle Scholar
  16. 16.
    Weed LL, Weed L. Medicine in denial. Charleston: Createspace; 2011.Google Scholar
  17. 17.
    Purves I, Fogarty L, Markwell D. The Holy Grail or poisoned chalice: the GP-GP record transfer project. Newcastle: HIRI; 2001.Google Scholar
  18. 18.
    Walker R. A general approach to addressing. ISO Workshop on address standards: considering the issues related to an international address standard. Copenhagen. 2008: 23–7.Google Scholar
  19. 19.
    Benson T. Why industry is not embracing standards. Int J Med Inform. 1998;48:133–6.CrossRefGoogle Scholar
  20. 20.
    Benson T. Prevention of errors and user alienation in healthcare IT integration programmes. Inform Prim Care. 2007;15(1):1–7.Google Scholar
  21. 21.
    Alderwick H, Robertson R, Appleby J, Dunn P, Maguire D. Better value in the NHS: the role of changes in clinical practice. London: The Kings Fund; 2015.Google Scholar
  22. 22.
    Kotter J. Leading change. Boston: Harvard Business School Press; 1996.Google Scholar

Copyright information

© Springer-Verlag London 2016

Open Access This chapter is licensed under the terms of the Creative Commons Attribution-NonCommercial 2.5 International License (, which permits any noncommercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license and indicate if changes were made.

The images or other third party material in this chapter are included in the chapter's Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the chapter's Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

Authors and Affiliations

  • Tim Benson
    • 1
  • Grahame Grieve
    • 2
  1. 1.R-Outcomes LtdNewburyUK
  2. 2.Health Intersections Pty LtdMelbourneAustralia

Personalised recommendations