Interoperability: how to apply it in hospital management

Interoperability is the ability of different systems to share information and data. It is a fundamental requirement for modern hospital management.

In many Brazilian hospitals, the physician who needs the result of a test performed at another unit still makes a phone call, waits and, when the information does not arrive in time, repeats the test. The laboratory runs on one system, the pharmacy on another, billing on a third. Each department works well on its own, but they do not talk to each other.

This fragmentation has a cost: repeated tests, accumulated administrative errors, denials caused by inconsistencies between systems and clinical decisions made with incomplete information. The answer to this scenario is precisely interoperability, and understanding it is a condition for any hospital management strategy.

What is interoperability in healthcare

Interoperability allows different systems, from different locations and departments, to exchange information securely and clearly, without manual adaptations.

This concept is not a synonym for simple integration.

Integration connects two specific systems, usually through a custom-built solution for that pair of platforms. Interoperability creates a common language that any system compatible with the standard can understand. Integration solves a one-off problem; interoperability solves the structural one.

In hospital practice, this means the electronic medical record, the billing system, the laboratory, the pharmacy and telemedicine platforms exchange information automatically, without barriers. The hospital gains a 360° view of its operation: from the patient’s arrival at reception to discharge and billing to payers.

The four levels of interoperability

Interoperability develops in layers, and each level represents an advance in the quality and impact of integration.

Basic level

This is the starting point. Systems can exchange data in a simple way, but manual intervention is still often needed to interpret the information received. The data arrives, but someone has to translate its meaning.

Structural level

There is a defined standard for the data format. Different systems process information quickly because they follow the same structure for sending and receiving. Manual intervention decreases, but the meaning of the data can still vary between platforms.

Semantic level

The meaning of the information is understood clearly and uniformly by all the systems involved. A diagnosis recorded in one system is interpreted correctly by another, with no risk of ambiguity or translation error. This is the level at which interoperability begins to directly affect clinical safety.

Organizational level

The most advanced stage. Interoperability becomes part of the institution’s strategy. Systems, workflows and data governance align with the hospital’s goals. The result is faster, more consistent decisions with full traceability.

The standards that make it possible: HL7 and FHIR

Interoperability needs a standard to work. These are technical protocols that ensure different systems actually speak the same language.

HL7 (Health Level Seven International) is the main family of international standards for exchanging health data. HL7 v2 became common in hospital integrations, representing events such as admission, discharge, test orders and results.

FHIR (Fast Healthcare Interoperability Resources) is the most recent evolution of this family: based on REST APIs and modern formats such as JSON and XML, it is lighter, more flexible and compatible with any system. With FHIR R5, the standard reached a new level of stability and granularity for medical specialties.

In Brazil, the Ministry of Health adopted FHIR as the basis of the National Health Data Network (RNDS), in line with the Digital Health Strategy 2020-2028. The FHIR br-core implementation guide, published in January 2026, adapts the standard to the Brazilian context and serves as a reference for hospitals, clinics and health plans.

ITMI-Brasil, the country’s first public smart hospital, uses an HL7/FHIR architecture as the basis of its entire digital infrastructure, integrating the electronic medical record, laboratory, pharmacy, electronic prescribing and pre-hospital regulation into a single ecosystem.

For private healthcare, the Brazilian standard is TISS (Supplementary Health Information Exchange), regulated by ANS (Brazil’s National Supplementary Health Agency). TISS standardizes the electronic exchange of information between providers and payers. It is therefore the foundation of hospital billing in private healthcare.

Impact on hospital management

Hospitals that have invested in interoperability see significant gains in four dimensions.

Faster, better-informed clinical decisions

With immediate access to the patient’s complete history, including tests performed at other units and previous prescriptions, the physician decides with more information and in less time.

Fewer denials and administrative errors

Inconsistent information between departments is one of the main causes of denials in hospital billing. When the clinical and administrative systems operate in an integrated way, the item recorded by the physician is already available to the billing specialist with the correct code and the linked documentation.

More robust financial management

Integrated data enables real-time cost control, tracking of performance indicators by department and early identification of operational inefficiencies.

A better patient experience

Less bureaucracy, fewer repeated tests and less waiting for information that already exists in another system improve the patient experience. Interoperability is, in the end, a choice to respect the patient’s time and safety.

The human factor and implementation challenges

Interoperability is often treated as a technical problem. In practice, it is as human as it is technological.

The obstacles most often reported by managers include the high upfront cost of integrating legacy systems, team resistance to change, the need to comply with the LGPD (Brazil’s General Data Protection Law) and the shortage of professionals specialized in digital health.

Hospitals that have been running for decades accumulate old platforms from different vendors that were not designed to talk to each other. Integrating this environment without interrupting operations is one of the industry’s biggest challenges.

The most sustainable strategy starts by choosing one critical, high-value workflow, such as test orders and results, admission and discharge, or medication reconciliation, instead of trying to standardize the entire institution at once. Mapping the essential information in that workflow, implementing a minimum circuit validated by the areas involved and publishing a clear catalog of what has been adopted creates the foundation to scale.

The cultural factor is also decisive. Breaking with old practices and trusting digital systems takes time, consistent internal communication and sponsorship from leadership.

Interoperability in Brazil: where we stand

Brazil has a structured national digital health policy. The Ministry of Health’s Digital Health Strategy 2020-2028 establishes interoperability as a central pillar, with the RNDS as the infrastructure for integrating patient data across the entire public system. The FHIR br-core guide, published in 2026, consolidates the country’s progress in standardization and serves as a technical reference for the industry.

In practice, there is still plenty of room to advance. According to the TIC Saúde 2024 survey on ICT in healthcare, only 37% of Brazilian healthcare facilities keep records exclusively in digital format. Most still operate with hybrid data (paper and system), which limits any interoperability strategy.

Integrated data, protected revenue

Interoperability has an impact that goes beyond care: it protects the hospital’s revenue. When the clinical and administrative systems speak the same language, the item recorded by the physician reaches billing with the correct code, the linked documentation and no inconsistencies that open the door to denials.

This flow connects interoperability and the revenue cycle directly. Rivio works in this layer, using artificial intelligence specialized in hospital billing, cross-checks clinical and administrative data, identifies inconsistencies before the claim is submitted and reduces losses that volume would make invisible.

Frequently asked questions about interoperability in healthcare

What is interoperability in healthcare?

It is the ability of different systems to exchange information securely, in a structured and understandable way, without manual intervention. In hospital practice, it means the electronic medical record, laboratory, pharmacy, billing and payers share data automatically, with the same meaning in every system.

What is the difference between integration and interoperability?

Integration connects two specific systems, usually through a custom-built solution. Interoperability creates a common language that any system compatible with the standard can understand. Integration solves a one-off problem. Interoperability solves the structural problem.

What are HL7 and FHIR?

HL7 is the main family of international standards for exchanging health data. FHIR is its most recent version, based on REST APIs, lighter and more flexible. In Brazil, the Ministry of Health uses FHIR in the RNDS and published the br-core guide in 2026 as the national reference for integrating health systems.

What are the benefits of interoperability for hospital billing?

Integrated systems reduce inconsistencies between what was recorded clinically and what was charged, cutting denials caused by coding errors or incomplete documentation. Hospitals that have integrated their clinical and administrative systems report up to a 30% reduction in denials. Interoperability also speeds up the billing cycle by eliminating manual reconciliation of data between platforms.

Where should a hospital start to implement interoperability?

The most sustainable strategy starts with one critical, high-value workflow: test orders and results, admission and discharge, or medication reconciliation. Mapping the essential information, implementing a minimum circuit validated by the areas involved and publishing a clear catalog of what has been adopted creates the foundation to scale. Trying to standardize the entire institution at once is the most common mistake on this journey.