System Interoperability vs Integration


Interoperability or Integration are critical to sustain adoption and implementation of any new digital health technology. To make an informed decision on the choice of integration vs interoperability, an understanding of the existing national health information systems and designing a road map to achieve the said objective is required. For example, where a national patient management system does not exist, you may consider exchange of data between systems instead of full system integration which typically requires more resource investment.

Integration refers to connecting applications so that data from one system can be accessed by the other one. This will typically involve a third party—middleware—that translates the data and makes it “work” for the receiving system. It is not a direct path for information to get from the adherence platform to the national information system and vice versa.

Interoperability is the ability of different technology systems and software applications to communicate, exchange data, and use the information that has been exchanged. For example, interoperability enables the option to open a DAT interface directly from the national patient management system and vice versa (as opposed to having to leave one and open the other.


  • Understand the premise of system interoperability vs integration - how they differ, how they may complement each other, and how they respectively could be achieved.

  • Understand what option works for your country (based on the findings of the national system assessment)

  • Understand how to define a road map for system interoperability or integration and how to implement this



Roadmap for System Interoperability or Integration

The health interoperability or integration ecosystem comprises individuals, systems and processes that want to share, exchange and access all forms of health information, including discrete, narrative and multimedia. Individuals, patients, providers, hospitals/health systems, researchers, suppliers and systems are potential stakeholders within this ecosystem. Each is involved in the creation, exchange and use of health information and/or data.

An efficient health interoperability ecosystem provides an information infrastructure that uses technical standards, policies and protocols to enable seamless and secure capture, discovery, exchange and utilization of health information. Several use cases exist based on how the maturity model [1] used, however we outline the basic use cases that can be achieved during the implementation infancy.

Receive and update patient demographic data

Receive clinical data from an external system and combine the data with an existing patient record.

  • National health system information: System containing the existing patient record

  • Adherence platform: System containing additional clinical data - patient adherence data

Exchange structured clinical data

Capability of a health information system to capture data in a specified structure and in a standardized format.

  • Exchange data in a readable, structured, and standardized format

  • Utilize controlled terminology

  • Definition of data/terms for consistency between end users

  • Ensure privacy and security standards are adhered to


The concept of integration - an example

One good example is the G Suite (Gmail, Google Docs, Google Calendar, etc.) - because these tools are integrated and activities happen behind a single login, data from your email can automatically create a calendar invite because the systems are integrated behind a single authorization process, such as logging into your Google account. Because the applications are fully integrated, any interaction or data change on one application can be seen or used by another. While integration does improve the seamlessly of interactions across applications, it is also the most involved technical process to integrate fully two or more technologies, applications, or systems.


The concept of interoperability - an example

An example of interoperability is between WhatsApp or other messaging apps on a smartphone, and the underlying operating system of the phone (Android, iOS, etc.). In that case, the operating system and messaging app are not integrated - the are developed completely separately, but have a defined communication process between them to exchange data. When you receive an incoming message on your phone and the application wants to notify you of the new message, there is an interoperability function that allows the messaging app to tell the operating system to notify you. That interoperability definition, or API, would have a list of defined variables (i.e. "Sender", "Sender profile picture", "Message", "Time of message") that each time the messaging app wants to notify you, it would have to supply the operating system with that information. The operating system only knows how to interpret that incoming information and display it to a user - different from integration, that data is temporarily sent between applications for an activity. The operating system could also store that information received from the messaging app (depending on the interoperability agreement), but what makes this interoperable is that the messaging app elects to send the data at a given point in time, and in a prescribed format, before the operating system to take action on the data.



Country Example India

In India, the Everwell adherence platform has been fully integrated with the national health information system, Nikshay [2]. NI-KSHAY-(Ni=End, Kshay=TB) is the web enabled patient management system for TB control under the Revised National Tuberculosis Programme (RNTCP). Nikshay is used by health functionaries at various levels across the country both in the public and private sector, to register cases under their care, order various types of tests from Labs across the country, record treatment details, monitor treatment adherence and to transfer cases between care providers. It also functions as the National TB Surveillance System and enables reporting of various surveillance data to the Government of India.


99DOTS is merged into Nikshay V 2.0 platform. The adherence calendar is visible inside Nikshay in the patient page and the overall adherence calendar for a district can be also viewed from the Patient Management menu. This unification reduced staff burden as they now only use one platform - Nikshay V 2.0 for registration, patient management, and adherence monitoring.

Relevant Research

Tools and resources

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