09 Oct 2021 technology healthcare

Interoperability is about communication.

Imagine needing a Gmail account to email people with Gmail addresses; a Hotmail account to email people with Hotmail addresses; a Yahoo account to email people with Yahoo addresses. And so on and so forth.

Luckily, that's not the world we live in; email accounts are interoperable. You can send emails from a Gmail address to any other email address. Contrast this with messaging apps, which are not interoperable. You do need a WhatsApp account to message people on WhatsApp; a Signal account to message people on Signal; a Telegram account to message people on Telegram.

This might feel like a minor inconvenience, and in the case of messaging apps, it is. But in other domains, it's a major problem. Take healthcare, for example. Hospitals, GP surgeries and clinics all use different systems, but it's critically important that they be able to communicate and share medical records with one another.

One solution to the problem of interoperability would be to force everyone to use exactly the same system. But this kind of forced monopoly risks all the typical issues associated with monopolies: higher prices, lower quality and lack of innovation. And more importantly, different groups have different needs; the needs of a GP surgery are not the same as those of a hospital, so it's highly unlikely that a single system could serve both effectively.

A much better solution to the problem of interoperability would be to let different organisations choose their own systems, so long as those systems are all interoperable. This is what we should be aiming for in healthcare and in many other domains.

One of the major features of interoperable systems produces a barrier to adoption. Interoperability produces network effects: the more systems there are communicating via a particular standard, the more valuable it becomes for your system to adopt that same standard. But until there are sufficient systems adopting a standard, there's much less intrinsic value to you in adopting it.

Perhaps the best way to avoid this kind of "cold start" problem is to get an authority to dictate that a particular standard must be used. For instance, the NHS might refuse to buy any systems that do not conform to the FHIR specification. This then creates an immediate incentive for developers to build systems adhering to FHIR, regardless of the number of existing systems that already adhere to it.