RESEARCH REPORT
Clinical Data Interoperability: Where the Gaps Actually Are
August 31, 2026
Summary
Report Summary
Interoperability standards like FHIR have made real progress on the technical problem of clinical data exchange. This report looks at where that progress has and has not translated into practices and health systems actually exchanging usable data — and what is driving the gap between standards adoption and real-world interoperability.
Where Interoperability Is Genuinely Working
- Structured clinical data (lab results, medication lists) exchanges reliably between FHIR-compliant systems
- Standards adoption is highest where data types are well-defined and bounded
- Large health systems have invested significantly in interoperability infrastructure
Structured, well-defined clinical data — lab results, medication lists, basic demographic and insurance information — moves reasonably well between systems that have adopted current interoperability standards. This is the category of data most FHIR implementations were designed around first, and it shows.
Where It Consistently Stalls
Two persistent gap patterns
Unstructured clinical narrative (physician notes, care plans) and the infrastructure gap between large health systems and independent practices are the two gaps that persist despite standards compliance.
The gap shows up in less structured clinical information: physician notes, care plans, and context that does not fit cleanly into a standardised field. Systems can exchange the structured data around a patient encounter while the actual clinical narrative — often the most useful part for a receiving provider — either does not transfer at all or arrives as an unstructured document dump that is technically “exchanged” but not genuinely usable.
A second consistent gap is between health systems that have invested heavily in interoperability infrastructure and the smaller independent practices and specialty clinics that have not, and often cannot justify the investment at their scale.
What This Means for Organisations Planning Investment
Investment aimed purely at standards compliance — checking the box on FHIR support — addresses the easier half of this problem. Closing the harder half requires specifically investing in structuring the unstructured clinical narrative and in integration approaches that work for smaller practice partners without requiring them to make an infrastructure investment proportional to a large health system’s.
Organisations treating interoperability as a compliance requirement rather than a genuine care-coordination investment are the ones most likely to end up with standards compliance and a data exchange gap that persists regardless.
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