When Standards Get in the Way

Why Pragmatism Matters in NHS Interoperability

Standards are a cornerstone of NHS interoperability.

FHIR, HL7 v2 and open APIs provide a shared language for how systems exchange data. They create the foundation for consistency, scalability and long-term sustainability across complex healthcare environments.

In principle, this is exactly what the NHS needs.

A common approach. Reduced duplication. Easier integration between systems and organisations.

But in practice, standards can also become a barrier to delivery.

Projects slow down while teams debate implementation details. Progress stalls as different interpretations of the same standard emerge. Perfect alignment becomes the goal, rather than practical outcomes.

What was intended to simplify integration can end up making it harder to deliver.

This is a pattern that appears across healthcare interoperability.

Standards are treated as something that must be implemented completely and correctly before anything can go live. Integration becomes dependent on achieving an ideal state, rather than delivering something that works in the real world.

The result is delay.

Or worse, no delivery at all.

This is not a failure of the standards themselves. It is a reflection of how they are applied.

Standards are enablers, not end goals.

They are designed to support interoperability, not to define it in absolute terms. When they are applied too rigidly, they can introduce unnecessary complexity and slow down progress at a time when the NHS needs results.

This is where pragmatism becomes critical.

Making interoperability work in practice means using standards in a way that supports delivery, not blocks it.

That might mean:

• Starting with a simplified implementation that meets an immediate need

• Agreeing a practical subset of a standard, rather than aiming for full coverage from day one

• Prioritising data flows that support real clinical use cases over theoretical completeness

• Iterating over time, refining and expanding as value is proven

This approach does not ignore standards. It uses them differently.

It recognises that the purpose of a standard is to enable systems to work together effectively, not to create additional barriers to progress.

In many cases, a pragmatic implementation that delivers value quickly is far more effective than a perfectly aligned design that never leaves the planning stage.

This is especially true in the current NHS environment.

Integrated Care Systems are under pressure to deliver outcomes, not just architecture. Teams have limited capacity. Expectations are high.

In that context, progress matters more than perfection.

A working integration that improves a referral process, supports a discharge or provides better visibility across a pathway will always deliver more value than a fully standards-compliant design that is still on the roadmap.

Over time, those pragmatic implementations can evolve.

Standards can be applied more consistently. Data models can be refined. Reusable patterns can emerge. But that evolution is built on something real — not theoretical.

This is how interoperability becomes sustainable.

Not through rigid adherence to standards from the outset, but through practical delivery that uses standards as a guide rather than a constraint.

Making interoperability work in practice means keeping the focus on outcomes.

Are systems connected in a way that supports care? Is data flowing when and where it is needed? Are clinicians able to access and use information through simple, user-facing interfaces?

If the answer to those questions is yes, then standards are doing their job.

Because ultimately, the value of a standard is not in how completely it is implemented.

It is in how effectively it helps deliver integration that works.

At Osprey, we work with the full range of standards that underpin NHS interoperability, from HL7 and FHIR through to national messaging, APIs and integration frameworks. Standards are important because they provide consistency, scalability and a common language for data exchange. But we also recognise that the ultimate goal is not compliance with a standard, it is delivering an outcome.

That means knowing when to apply standards rigorously, when to adapt to the realities of existing systems and how to strike the right balance between architectural purity and practical delivery. Our focus is always on achieving meaningful results for clinicians, organisations and patients, using standards as an enabler rather than an end in themselves.

Related Solution: Contemporary Architecture

Standards are important, but they should support delivery rather than become obstacles. Discover Osprey's pragmatic approach to interoperability architecture.