My View - Interoperability & consumer access: is it time for regulation?

VIEW - Peter Jordan, Fellow of HiNZ and Health Information Standards Implementer 

Last night I logged into my health and wellness app - following a GP consultation earlier in the day. It confirmed that the practice has sent an update, but I noted the absence of a reason for prescribing a new medication; therefore, I sent a response message asking for that data to be added to my record. I also created permissions to enable other members of my care team to see the new data prior to an appointment the following day… 

…and then I woke up and realised that I’d been dreaming. An hallucination based on a related fantasy that interoperability and consumer access to healthcare data can be achieved without regulatory intervention. Instead, the reality is a world where lip-service is paid to various standards unsupported by conformance and compliance requirements; intermittent funding is made to selected software suppliers to exchange their own proprietary data formats; and patient portals with read-only data are tethered to practice management systems. 

The New Zealand context 

The goal of interoperability is cited in virtually every single health information strategy and investment plan produced in New Zealand in the last 2 decades. The latest being the Health Digital Investment Plan published in November 2025. However, this excellent document does provide pointers to a way forward that takes us beyond the madness of continuing to expect this outcome by continuing to do the same things. 

In particular, the highlighted phrases this excerpt from the Data & Interoperability Section on Page 7: 

“We will enable the secure and seamless flow of health data across the system. We will do this by establishing and enforcing common data standards across the sector, creating a national data catalogue, and building a modern, standards-based interoperability platform using international best practices” 

and this ‘horizon’ listed on Page 26: 

“Approved health app developers can use national API resources to create innovative tools for patients that securely connect to the patient's health record” 

Obviously, these entries do not directly call out the need for regulation, but they should encourage us to see if other countries are moving in that direction, and even a cursory glance outside the shores of New Zealand reveals that several countries have established or are actively developing regulations regarding interoperable healthcare data. 

The global context 

Arguably leading the way in 2016, the 21st Century Cures Act in the USA prohibits information blocking and mandates that patients have free, electronic access to their medical records. This has been supported by government regulations stipulating the use of HL7® FHIR® APIs to provide access to consumers and payers. 

This legislative path has been followed in the EU by the European Health Data Space which mandates that Electronic Health Record systems must meet specific, standardized interoperability requirements to allow for seamless exchange.  

In Australia, The Modernising My Health Record (Sharing by Default) Act 2025 establishes requirements for healthcare providers to upload key health information to My Health Record by default. This represents a significant shift from voluntary participation to mandatory upload requirements for certain providers. 

Health interoperability in the UK is now primarily driven by the Data (Use and Access) Act 2025, which mandates technical standards for IT suppliers and providers. This legislation enforces compliance with interoperability standards—such as FHIR—to ensure seamless data sharing across the NHS and social care. 

Following closely behind are Canada and Ireland both with new legislation to support standards-based interoperability and patient access, so is it time for New Zealand to follow suit and adopt similar legal mandates? 

The case for regulation 

While I would answer that question with a firm ‘yes’, it’s with the caveat that regulation of itself is not a silver bullet and, critically, needs to be supported by investment. 

It’s easy to look at our current state and see that most health information data is not fit for purposes beyond that for which it was originally collected. Certainly, that is my experience based on decades of working on national interoperability projects such as GP2GP patient notes transfers and the NZ e-Prescription Service. 

That is not to blame the numerous software suppliers engaged in those and other similar projects. Their products are principally designed for the purposes of managing healthcare facilities and running practices and, consequently, scheduling and reimbursement related to patient encounters takes precedence over the creation of interoperable patient records. 

Naturally, vendors will prioritise new functional features that enhance their clients’ user experience and generate revenue rather than implementing changes that only appear to have downstream benefits. In NZ at least, it’s a low margin business and interoperability does not provide a competitive edge. As many have noted, it’s not a boat race - we are all effectively paddling in the same vessel. 

The need for investment 

Therefore, it’s clear that regulation needs to be supported by investment. Suppliers need financial incentives – preferably carrots rather than sticks - to comply with standards, and build APIs, that benefit us all in the long run but might otherwise have an adverse short-term effect on their profit margins. 

Furthermore, without the development of standards-based APIs, it’s difficult to foresee the emergence of a market for apps that enable engaged consumers to manage their own health and wellness data. It’s also highly likely that any project attempting to facilitate the sharing of patient records can produce significant benefits without structured, standards-conformant, data. 

We all know that dreams are free; in reality, experience should be teaching us that interoperability and consumer access both require regulation backed by investment. The time has come to put that into practice. 

Disclaimer: The opinions expressed in this article are purely personal and do not represent the views of my former clients, HL7 New Zealand, HL7 International or generative AI. 

If you want to contact eHealthNews.nz regarding this View, please email the editor Rebecca McBeth.

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