That is why interoperability is becoming a new discipline in healthcare governance. It is the language of the modern system: a language of standards, trust, security, innovation, and connected care.
Written by: Azir Aliu
In healthcare, every piece of information carries human value. Behind every laboratory result stands a patient waiting for an answer. Behind every electronic referral stands a doctor who must make a timely decision. Behind every registry stands a system that must know where there is need, where there is risk, and where it must respond more quickly.
That is why digitalization in healthcare is not merely a technical process; it is a new way of organizing trust. It is a transition from fragmented information to connected knowledge, from isolated systems to a shared architecture, from administrative records to an intelligent public service.
In my previous column, I wrote about the Digital Health Strategy 2026–2030 as the foundation of a new architecture of trust within the healthcare system. That framework is important because digitalization must not be reduced to the introduction of new digital solutions. True digital transformation means changing the way the healthcare system thinks, operates, processes information, makes decisions, and creates public value.
In this column, I focus on the first pillar of the strategy – standards-based interoperability and connected healthcare. At first glance, this may sound like a technical subject. But in essence, it is one of the most important systemic reforms. Interoperability is the healthcare system’s ability to speak one language: a language of accurate data, shared standards, secure exchange, institutional accountability, and better patient care.
Without that common language, digitalization may produce many systems, but very little real connectivity. Data may exist, yet still not work sufficiently for the patient. Information may be entered, yet not be easily usable for the physician. The system may be digital, but not intelligent enough.
This is where the essence of the first pillar begins. Its goal is not merely to connect computers, but to connect processes, institutions, rules, and decisions. Interoperability means that data does not move chaotically, but according to standards. It means that access to information is not accidental, but regulated. It means that every digital investment must have its place within a broader national architecture.
A significant digital foundation already exists within the healthcare system. Various institutions have developed information systems that daily support appointments, financing, contracts, registries, laboratory results, clinical processes, and public health data. In many cases, these systems produce results within the institutions for which they were created. However, a large number of them were not designed with a sufficiently clear vision that one day they would need to communicate with other systems, exchange data according to common standards, and become part of a national digital health infrastructure.
Thus, a paradox is created: information exists in digital form, yet when it needs to move beyond institutional boundaries, it still too often travels through paper, printed reports, CDs, or manually delivered documents, rather than through a secure national highway for health data. This means that the system is digitalized in separate segments, but still not sufficiently connected as a whole.
That is why our task is not to begin from zero, nor to invalidate what has already been built. On the contrary, the task is to introduce order, standards, and lasting connectivity into the existing digital foundation. Systems that today function as separate institutional solutions must gradually become part of a shared national architecture in which data moves securely, lawfully, and usefully — not through paper and physical carriers, but through an organized, standardized, and trustworthy digital infrastructure.
Therefore, the next step is not merely the technical connection of existing systems. The next step is the establishment of common rules according to which health data can move securely throughout the entire system. It must be clearly defined how data is created, how it is recorded, how it is exchanged, who has the right to access it, under what conditions, and with what responsibility.
Only in this way can information preserve its value even when it leaves the institution where it was created. A laboratory result, radiological finding, discharge letter, or clinical report should not be merely a document transferred from one place to another. It should be structured, understandable, and trustworthy health information that can be used across different parts of the system, without loss of meaning, without unnecessary repetition, and without administrative barriers.
This is the essence of interoperability. It does not simply mean that systems are connected, but that data is understood in the same way. If different institutions use different labels, different formats, and different recording logics, then information becomes difficult to compare, analyze, and use for better medical or managerial decisions. That is why the strategy foresees a national function for terminology and standards, which will ensure that health information has a stable, verifiable, and shared meaning throughout the system.
In modern healthcare, analytics, predictive planning, and artificial intelligence cannot function on disordered data. No algorithm can produce a trustworthy recommendation if the system speaks in different languages. That is why interoperability is not only a present necessity, but a prerequisite for the next generation of digital healthcare: healthcare that learns, predicts, responds, and improves based on high-quality data.
This transformation is especially important for doctors. Physicians should not lose time searching for, interpreting, or verifying whether certain data exists in another part of the system. Information should be structured, accessible, and secure according to clear systemic rules. In this way, unnecessary repetition of examinations is reduced, gaps in medical history are avoided, and a stronger foundation for medical decision-making is created.
But interoperability also has an important economic and governance dimension. It directly affects the way the state procures digital solutions. If every new public procurement creates a closed system, the state over time ends up with an expensive, poorly connected, and dependent digital infrastructure. That is not modernization, but an accumulation of technical islands.
That is why the new principle is clear: the public healthcare system should procure solutions that can communicate, be tested, upgraded, and integrated into a common digital architecture. This is not a restriction of the market, but a protection of the public interest. Open standards bring greater competition, greater transparency, and less dependency on individual suppliers.
When the state invests in digital healthcare, it must not purchase only a product. It must purchase capacity for the future. Every new investment should increase the value of the whole, rather than create another isolated technical space.
This approach also requires a realistic assessment of the digital readiness of healthcare institutions. We cannot plan modernization based on assumptions. A clear picture is needed: what systems hospitals and clinics use, how connected they are, what equipment they possess, what their security capacities are, how prepared they are for modernization, and what support medical staff require.
Here lies the difference between spontaneous and planned digitalization. Spontaneous digitalization creates visible but often short-lived solutions. Planned digitalization creates sequence: first assessment, then standards, then modernization, then compliance verification, and finally system expansion. It may appear to be a slower path, but in healthcare, speed has value only when accompanied by reliability, quality, and trust.
The first pillar also opens the European pathway for digital healthcare. If we want our healthcare system to become part of the European health space, we must already begin building our systems according to standards that will enable the cross-border use of health data. Electronic prescriptions, laboratory results, radiological images, discharge reports, and other medical documentation that we use domestically — the more organized they are, the more prepared they will be for a European context as well.
That is why interoperability is far more than a technical framework. It is a discipline of modern healthcare governance. It introduces order where fragmentation once existed, establishes rules where each system had developed according to its own logic, and transforms information into a resource for treatment, prevention, planning, and development.
Our goal is a healthcare system in which every digital investment has its functional place within a greater whole. A system in which data is not confined to technical silos, but managed as a resource with clear standards, strict protection, and high public value. Through this approach, public money will build lasting infrastructure, rather than short-term solutions.
Interoperability, whose foundations we are establishing through the strategy, does not end within the healthcare system alone. It is part of a broader national digital architecture in which institutions exchange data securely, lawfully, and in the interest of citizens. In this process, the Ministry of Health assumes its share of responsibility: to create a standardized healthcare system prepared for integration with other national systems.
Ultimately, healthcare that speaks one language does not simply mean systems that are connected. It means a patient who no longer has to carry medical history from one counter to another. It means a physician who has trustworthy information when making decisions. It means institutions that plan based on data, not assumptions. It means a state that does not improvise, but builds an infrastructure of trust.
That is why interoperability is becoming a new discipline in healthcare governance. It is the language of the modern system: a language of standards, trust, security, innovation, and connected care. Only in this way can the healthcare system become faster, fairer, more intelligent, and prepared for the European future.
The author is Minister of Health in North Macedonia.