UK Healthcare IT Interoperability: A Pragmatic Guide — how Data Interops makes it real
- Naveed Akhter
- 3 days ago
- 3 min read
The UK is standardising on FHIR UK Core, BaRS (Booking and Referral Standard), and document & data–sharing patterns (NRL, Shared Care Records, IHE MHD/MHDS, QEDm). At the same time, many Trusts/ICBs still operate HL7 v2, EDIFACT via MESH, and XDS SOAP stacks. Winning teams are taking a pragmatic migration path: keep the lights on for legacy, implement clean FHIR-first interfaces for new flows, and incrementally backfill mappings (SNOMED CT, dm+d, and where needed LOINC) to improve semantic quality and downstream EPR ingest.
Data Interops helps NHS providers, ICSs and vendors bridge from ‘as-is’ to ‘to-be’ with production-grade integration, clinical safety documentation, and upgradeable architectures.
What UK stakeholders are asking for (and moving towards)
1) Patient & record identity
NHS Number as primary identifier; PDS as source of truth
CIS2/NHS Login OIDC for workforce/patients
2) FHIR-first flows
UK Core–conformant resources; BaRS workflows for referrals & bookings
FHIR APIs for GP Connect, NRL, Shared Care Records (via MHD/MHDS/QEDm patterns)
3) Standards-aligned clinical content
SNOMED CT for clinical terms; dm+d for medicines; LOINC in laboratory scenarios where SNOMED coverage is incomplete or where EPRs expect it
4) Trustable, governable platforms
DTAC, DSPT, DCB0129/0160, Cyber Essentials+; auditability, consent, and information governance baked in
5) Cloud-ready, event-driven integration
Modern API gateways, message mediation, and analytics pipelines that coexist with PACS/LIS/RIS/EPR estates
What still exists in the wild (today)
Pathology: EDIFACT (PMIP) and HL7 v2.x (LTW/LAW) widely used; FHIR-on-MESH is rolling out
Documents: IHE XDS.b SOAP still common; many regions also run MHD/MHDS front-ends
EPR landscape: Mixture of Epic, Oracle Health/Cerner, Altera, System C, TPP/EMIS and bespoke systems — each with different API postures
Terminology reality: SNOMED CT is mandated, but many lab/EPR contexts still prefer or support LOINC+SNOMED combinations
Data Interops: how we help
1) Legacy → FHIR uplift (without breaking today)
HL7 v2/EDIFACT ingestion via interface engines (Mirth/Rhapsody) and our adapters
Deterministic mappings to FHIR R4 (DiagnosticReport, Observation, ServiceRequest, Specimen, DocumentReference, Task)
Validation pipelines against UK Core/BaRS IGs; rich error telemetry for ops teams
Referrals & bookings (BaRS)
BaRS is the FHIR uplift path for today’s mixed referral mechanisms; the sequence view shows how new BaRS messages coexist with incumbent flows during transition.
2) Document and data sharing that works regionally
MHD/MHDS gateways to Search/Retrieve/Submit documents with proper metadata
NRL pointer publishing/consuming; QEDm façades to expose fine‑grained clinical data
XDS bridging to protect prior investments while introducing FHIR REST
3) Terminology & semantic quality
SNOMED CT authoring and dm+d alignment for meds
LOINC cross-maps for diagnostics where SNOMED is sparse or EPR ingest expects LOINC
Automated vocabulary services (CTS2/TS) + integrity checks in CI/CD
4) Safety, assurance & procurement readiness
Clinical Safety documentation (DCB0129/0160)
DTAC evidence packs; DSPT controls and CAF-aligned security
Architecture runbooks, IG/consent models, DPIA and threat models
5) Operating model
24×7 support SLAs, on-call integration SREs
Change management, configuration-as-code, and pre‑prod conformance testing
Why Data Interops
Domain breadth: Labs, imaging, pathology, genomics, community & acute — we work across pathways
Standards fluency: HL7 v2/EDIFACT, FHIR R4/UK Core, IHE (XDS/MHD/MHDS/QEDm), DICOM/DICOMweb
Semantic muscle: SNOMED CT authoring; dm+d integration; pragmatic LOINC mappings for EPR compatibility
Assurance: Full DCB0129/0160 packs; DTAC & DSPT readiness; Cyber Essentials+ aligned controls
Velocity with safety: DevSecOps pipelines, conformance tests, replay harnesses and canarying
