The promise of digital health is that the right information reaches the right clinician at the right time. The reality, after decades of investment, is that most health systems in New Zealand still can't share basic patient information reliably. Interoperability isn't a nice-to-have. It's the foundation that everything else depends on, and we're still getting it wrong.
What You Need to Know
- Health system interoperability means different clinical systems can exchange patient data in a structured, meaningful way. Most systems in NZ can't do this beyond basic demographics.
- The cost of poor interoperability is borne by patients: repeated tests, delayed referrals, lost clinical context when moving between providers, and clinicians making decisions with incomplete information.
- The barriers are not primarily technical. They're commercial (vendors protecting market share), structural (no mandated standards), and cultural (organisations that don't trust each other with data).
- New Zealand's Hira programme aims to create a shared health information platform. Whether it succeeds depends on solving governance and vendor cooperation problems, not technology problems.
What Interoperability Looks Like in Practice
At RAPHS, I managed information systems that needed to communicate with hospitals, laboratories, community health providers, and government agencies. In theory, digital health should make this seamless. In practice, we spent enormous effort on what should have been simple.
Sending a referral from a GP to a hospital specialist should be one step. In reality, it often involved exporting data from one system, reformatting it, and importing it into another. Lab results would arrive in one format from one laboratory and a different format from another. Patient demographic updates from the national health index would sometimes overwrite local records with less accurate information.
30%
of clinical information is unavailable to NZ health professionals at the point of care due to system fragmentation
Source: Health Quality & Safety Commission NZ, Atlas of Healthcare Variation, 2021
Each of these failures is small on its own. A referral that takes ten minutes instead of one. A lab result that needs manual re-entry. A medication list that's incomplete because the pharmacy system doesn't talk to the GP system. But across a health network serving tens of thousands of patients, these small failures compound into a systemic problem.
Why It's So Hard
Interoperability has been a stated goal of health IT for at least twenty years. The fact that we're still struggling with it tells you that the barriers are deeper than technology.
Commercial incentives work against it
Health IT vendors benefit from lock-in. When a practice is deeply embedded in a vendor's ecosystem, switching costs are high. Vendors have limited commercial incentive to make their data easily portable to competitors. Some actively resist interoperability standards because their market position depends on being the system of record that other tools connect to on their terms.
$12.8B
annual cost of health IT interoperability failures in the US, extrapolated to ~$300M for NZ by population
Source: West Health Institute, The Value of Health IT Interoperability, 2019
This isn't unique to health, but the consequences are uniquely serious. In health, vendor lock-in doesn't just cost money. It costs clinical time and, in extreme cases, affects patient safety.
No mandated standards
New Zealand doesn't mandate specific interoperability standards for health IT. There are guidelines and frameworks, but adoption is voluntary. The result is a patchwork of implementations where systems that claim to support the same standard can't actually exchange data reliably because they've each implemented it differently.
HL7 FHIR is gaining traction globally as a health data exchange standard. Some NZ vendors support it. Many don't. And even among those that do, the implementation varies enough that "FHIR-compliant" doesn't guarantee interoperability.
Trust deficits between organisations
Sharing patient data between organisations requires trust. Trust that the receiving organisation will handle the data appropriately. Trust that their systems are secure. Trust that the data will be used for clinical purposes, not commercial ones.
In New Zealand's health sector, that trust is uneven. DHBs, PHOs, and community providers don't always have the data sharing agreements, technical infrastructure, or cultural alignment to share data confidently. The result is that data stays siloed even when sharing would clearly benefit patients.
We've been talking about interoperability for twenty years. The technology has been ready for most of that time. What's missing is the governance, the standards enforcement, and the willingness to put patient benefit ahead of organisational convenience.
Rikimata Massey
Health CIO Advisory
What It Costs Patients
The people who pay for poor interoperability are patients.
A patient who moves from one region to another shouldn't have to retell their medical history. But they do, because their new GP can't access records from their previous one.
A patient with a chronic condition being managed across primary and secondary care shouldn't have conflicting medication lists. But they do, because the hospital system and the GP system don't share medication data in real time.
A Māori health service running a community wellness programme shouldn't have to manually reconcile data from three different systems to get a complete picture of their client's health. But they do, because those systems were never designed to work together.
These aren't hypothetical scenarios. They're the daily reality of health IT in New Zealand.
A Path Forward
The Hira programme, led by the Ministry of Health, is New Zealand's most ambitious attempt to solve this problem. It aims to create a national platform for health information sharing, giving clinicians access to a more complete patient record regardless of which system they use.
Whether Hira succeeds depends on several things. Vendor cooperation, which will require either incentives or mandates. Standards enforcement, which means moving beyond voluntary adoption. And governance that includes community voice, particularly Māori voice, in decisions about how shared health data is managed.
The technology for interoperability exists. FHIR, API-based architectures, and cloud platforms make it technically feasible to share health data at scale. The challenge is everything around the technology: commercial alignment, organisational trust, governance frameworks, and the sustained political will to make it happen.
Until we solve interoperability, every other digital health investment delivers less than it should. Better clinical tools, population health analytics, preventive care programmes - they all depend on data flowing where it needs to go. Right now, it doesn't.