Why Standards Are Not Enough to Guarantee End-to-End Interoperability

Standards have been instrumental in achieving the significant level of systems interoperability we rely on in almost every domain. Many organizations are betting on the ability of standards to provide unprecedented end-to-end systems interoperability with partner organizations. Our experience suggests that the expectation of what can be achieved with standards is too high. For example, many large health care providers assume that moving to a new version of a major health care standard (HL7 3.0 and the associated reference information models) will guarantee "seamless" interoperability across all health care systems inside the enterprise. However, this new standard does not take into account clinical workflows and operational contexts that differ across point-of care systems and have a large effect on how accurately clinicians interpret data. This paper offers a caution, not that standards are not useful but that organizations need to be aware of limitations of standards they are adopting to achieve systems interoperability. After discussing these limitations, we present some strategies to minimize their effect.