Health systems interoperability: fewer disruptions along the care pathway

A patient sees a doctor, goes to the laboratory, comes back with a result, collects a prescription at the pharmacy, and the cost of care must then be settled by a health insurer. Five steps, often five separate systems, and the same information has to pass through all of them. When those systems cannot exchange data, the patient, a relative or an administrative clerk ends up carrying it by hand. Health systems interoperability is about the opposite: moving the right information between the actors of the care pathway, so that nobody has to act as the messenger.

This article covers the essentials for health ministries, development partners and hospital IT leaders: what the term means, what the main standards (HL7, FHIR, IHE) each do, where French-speaking Africa stands, and what Eyone Medical contributes.

When information takes the wrong bus

The pattern is familiar. The clinical report exists, but it stays inside the software of the department that produced it. The test result is ready, but on paper at the laboratory. The claim is complete, but it travels to the payer by courier and comes back with missing items. Everyone has done their job; the information simply took the wrong bus.

These breaks in the pathway carry costs that are rarely measured. For patients, they mean extra trips, waiting, and retelling their history at every desk. For clinicians, they mean re-keying data and making decisions without the full picture. For payers, they mean late visibility of the services delivered.

What interoperability means

Senegal's Digital Health Strategic Plan 2018-2023 offers a working definition: interoperability is the ability of a product or information system to function with other products or systems, existing or future. In practice, it operates on several levels:

• technical: systems can connect and transmit data;
• syntactic: messages share a common structure that each system can parse;
• semantic: a code means the same thing everywhere, whether it designates a test, a medicine or a procedure;
• organisational: the actors have agreed on who exchanges what, when, and under which confidentiality rules.

A project that only addresses the first level connects machines. A project that addresses all four connects institutions.

HL7, FHIR and IHE: who does what

These three acronyms often appear in digital health specifications. They are not competitors; each fills a different role.

HL7 Version 2: the hospital messaging workhorse

HL7 International has published health data exchange standards for decades. Its Version 2 is a messaging standard. The US National Library of Medicine describes it as the most used health information exchange standard in the United States, with common message types covering patient movement (admission, discharge, transfer), orders to laboratories or pharmacies, test results, clinical reports, billing and scheduling. It is robust, but demanding to implement, because each site tends to adapt it in its own way.

FHIR: the next generation

HL7 presents FHIR (Fast Healthcare Interoperability Resources) as a next-generation standards framework that builds on its earlier product lines while using current web technologies. Information is broken into modular "resources" (a patient, an observation, an appointment) that can be assembled as needed and exchanged through RESTful interfaces. The current published version on the HL7 website is R5. In July 2023, the World Health Organization signed a collaboration agreement with HL7 International to support the adoption of open interoperability standards, describing FHIR as a principal standard for person-centred digital solutions.

IHE: the rulebook for combining standards

IHE (Integrating the Healthcare Enterprise) does not write standards. It defines integration profiles that specify how existing standards, such as HL7 or DICOM, are combined for a given use: matching a patient's identity across systems, sharing a document between two facilities, keeping an audit trail of access. It also runs vendor testing events and a conformity assessment programme, which is what turns a promise of openness into a verifiable tender requirement. We cover this in a dedicated article: IHE certification in Africa: what Yone-Wi's interoperability engine proves.

French-speaking Africa: where things stand

The starting point is often the same: many initiatives, few links between them. Senegal's Digital Health Strategic Plan 2018-2023 recalled that a 2015 assessment had identified more than 50 eHealth and mHealth initiatives, described as fragmented, uncoordinated and often non-interoperable. The plan called for a national reference framework for health information system standards and interoperability.

The framework is also taking shape at continental and global level. In 2023, Africa CDC published the African Union Health Information Exchange Guidelines and Standards. In May 2025, the World Health Assembly extended the Global Strategy on Digital Health to 2027 and asked WHO to develop a new strategy for 2028-2033.

Three features make the task demanding in the region:

• a diverse set of actors: public facilities, private clinics, pharmacies and a range of payers, including Senegal's IPMs (employer-based health insurance institutions);
• paper and digital records side by side, which calls for gradual transitions rather than a single switch-over;
• data governance: where data is hosted, who can access it and under which rules. These questions need answers before any project begins.

What Eyone Medical contributes

Eyone Medical describes itself as a medical interoperability platform: it connects the stakeholders of the care pathway. It does not ask a facility to replace everything; it connects what is already there. Founded in 2015, it operates in Senegal, Côte d'Ivoire and Gabon.

• A certified engine. In 2024, the Yone-Wi interoperability engine obtained IHE certification, the first in Africa.
• A network connected since 2021. That year, 322 private health facilities were connected to IPMs for the insured patient pathway.
• National scale. In 2023, Eyone Medical won the tender for the electronic health record of Senegal's national health system, piloted in 2024. In 2025, it won the tender for the mandatory health insurance interoperability platform, which will connect the 177 IPMs to all health facilities in Senegal.

In practice, three products work together: Medical IS for hospitals, clinics, practices and pharmacies; Eyassur for insurers, IPMs and mutual health organisations, including electronic claims transmission; and the Medical Passport, which lets patients keep control of their own record. The electronic health record raises the same questions at national scale, as discussed in our article on the electronic patient record and the care pathway.

Where to start

Whether you lead a national programme or a single hospital's information system, the sequence is the same:

1. Map the flows: who produces which information, who needs it, and at what point in the pathway.
2. Settle patient identity: without a reliable identifier across systems, no exchange is safe.
3. Choose the standards: HL7 Version 2 or FHIR depending on the systems in place, IHE profiles for critical exchanges, shared terminologies.
4. Require verifiable evidence of conformance rather than promises of openness.
5. Set the governance: hosting, access rights, audit trails and consent.

Would you like to see how these exchanges work in a facility or a programme? Request a demonstration, or browse our full range of solutions.

Frequently asked questions

What is health systems interoperability?

It is the ability of the information systems used by different actors (facilities, laboratories, pharmacies, payers and patients) to exchange data and interpret it in the same way, so that information follows the patient along the care pathway.

What is the difference between HL7 and FHIR?

Both are published by HL7 International. HL7 Version 2 is a messaging standard widely used in hospitals. FHIR is the next generation: modular resources exchanged through web interfaces, easier to integrate into modern applications. The two often coexist.

Do you need to replace existing software to become interoperable?

Not necessarily. The aim is to make existing systems exchange information through shared standards. That is the principle of an interoperability platform: connect rather than replace.

What does an IHE certification add?

It shows that a specific product implements defined IHE profiles. Eyone Medical's Yone-Wi engine obtained IHE certification in 2024, the first in Africa. Our article on IHE certification in Africa explains what it covers and how to check it.