Interoperability in Healthcare: A Primer and New Frontiers

Interoperability in healthcare remains difficult despite decades of standards and infrastructure. Although messaging protocols and standards enable systems to exchange data, they do not guarantee that clinical meaning is preserved across organisations, workflows, and cultural contexts. This persistent gap between where semantics are used in care and how they are exchanged continues to drive fragmentation, bespoke mappings, and costly manual integration.

This tutorial offers a primer and a forward-looking agenda by framing interoperability as three generations. We first revisit the pre-interoperability era of proprietary systems and point-to-point integrations. We then cover the standards-based second generation, highlighting what it solved (e.g., connectivity) and what it left unresolved (e.g., semantic alignment). Finally, we outline an emerging third generation towards true interoperability, and conclude with research directions for building interoperability in the AI era.

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• Bibtex:

  @article{ionescu2026interoperability,
  title={Interoperability in Healthcare: A Primer and New Frontiers},
  author={Ionescu, Andra and Carbone, Paris and Meijer, Sebastiaan and Koutras, Christos and Freire, Juliana and Hose, Katja and Raghothama, Jayanth},
  journal={Proceedings of the VLDB Endowment},
  volume={19},
  number={12},
  pages={4912--4917},
  year={2026},
  publisher={VLDB Endowment}
  }