On a return trip from San Jose to Sydney some years ago, American Airlines cancelled my connecting flight from San Jose to LAX. I begged my way onto a Delta Airlines flight to LAX that would just about make it, if there were no delays. Normally, if the AA flight from San Jose is delayed for a short time, the Qantas flight to Sydney would wait at LAX. But because Delta had no commercial relationship with Qantas, the information about me was not transmitted. As I sprinted through the terminal at LAX to the Qantas counter I prayed I would make it in time. I did, just.

This was an interoperability issue because there were no communication channels between Delta and Qantas.

Why is interoperability testing important?

When you take your car to get registered, you must comply with testing that ensures your vehicle is roadworthy. If you drive a car with severe or hidden issues, you run the risk of endangering other people’s lives.

We take the same attitude toward interoperability testing in healthcare. If systems are not tested, issues analysed and resolved, results may not be correctly transmitted or they may be misinterpreted and someone could make a mistake that impacts a patient. Before you introduce FHIR standards or any new technology to your healthcare organisation, you need to ensure the entire end-to-end system works as it should.

In essence, this is the next step after you have decided to implement interoperable solutions in your healthcare organisation. I wrote about getting started with interoperability in healthcare last year; I recommend reading that blog first.

What is interoperability testing in healthcare?

Interoperability testing focuses on improving overall system data quality by ensuring the compatibility of two applications. When two systems in healthcare cannot communicate with each other effectively, the data shared might have inaccuracies, causing delays in treatment, wrong diagnoses, or putting patient lives at risk.

Interoperability testing prevents these issues by identifying and troubleshooting any problems with data exchange. It ensures that systems, applications and devices communicate effectively and as they should. In the case of systems not designed to interoperate it ensures there are appropriate integrations. When healthcare providers have systems that communicate in such a way, they improve their decision-making and real-time responses.

Testing also ensures that data delivery occurs in a consistent format using a standard such as FHIR, to mitigate data errors. The data becomes easier for everyone in the organisation to interpret and understand because people do not need to make sense of different formatting each time they receive data.

The process of interoperability testing in healthcare

Interoperability testing in healthcare analyses three key areas:

Functional and non-functional testing

When it comes to interoperability testing in healthcare, there are two main types of testing: functional and non-functional. 

Functional testing ensures systems can actually communicate with each other and accurately transfer data and that the data can be understood. Adhering to a common standard, like FHIR, facilitates functional interoperability. Non-functional testing, on the other hand, ensures that the system and network architecture are suitable, that the system can handle the expected load and perform satisfactorily and that the correct security protocols are in place.

This testing phase requires documented test cases that cover all functional and non-functional aspects, running the tests and noting down results, resolving issues, and repeating this until all issues are resolved or accepted. All applications, devices and other components of the system need to be tested during this phase.


A key reason for interoperability testing in healthcare, and a key challenge that comes with it, is maintaining compliance, for example with Australia’s strict data privacy regulations. 

By testing the systems to ensure they can exchange data accurately and securely, healthcare organisations can minimise the risk of compromising patient privacy caused by a lack of compliance. A data breach could result in serious consequences for a healthcare organisation that has not taken the necessary steps to maintain compliance, including fines and reputational damage.

Testing for end-users

Interoperability testing in healthcare is not just for the IT department. It is also for the end-users leveraging the systems every day. By testing the systems in known conditions, such as a sandboxed environment, you can ensure they are easy to use and transfer data accurately. You can also test the system’s ability to handle a high volume of requests.

Types of interoperability testing in healthcare

Data testing distinguishes between the data type and the data format. These are two different concepts and must not be confused. Testing the data type ensures that contradictions do not occur when sending data from one system to another, for example, measuring temperatures in Celcius vs Fahrenheit. Data format testing ensures consistent data format between where the data was sent and received, such as appearing in JSON or XML at both ends.

Semantic testing ensures the data transfer algorithm operates reliably between the two systems. For example, RESTful APIs.

Protocol testing monitors the protocols that transfer data between systems. It primarily ensures these protocols provide robust data security.

Physical testing examines the hardware supporting the interoperable platforms. It includes checking the ports and cables leveraged during data transfer and examining whether the device transported the data at an appropriate speed.

The first three of these – data, semantic and protocol testing – is enforced by a robust standard such as FHIR.

What are the challenges of interoperability testing in healthcare?

Adopting standards such as FHIR

For different systems to exchange data, they need to use a common standard. One of the most commonly used standards for healthcare interoperability, that is widely supported by the major technology vendors, is FHIR. A key challenge to interoperability testing in healthcare is adopting a standard such as FHIR.

Interoperability testers will need to ensure they leverage platforms and applications compatible with FHIR and ensure resources such as patient medications and diagnostics, care provision, and billing are accessible within this standard.

Data fragmentation

Another key challenge to interoperability testing in healthcare is data fragmentation, which occurs when data exists in silos. Data fragmentation makes it difficult for different systems to exchange data.

One way to overcome this challenge is to use a system to consolidate the data from different systems into a single location.

Testing in the real-world

Real-world testing is a key challenge in healthcare interoperability. Healthcare data is complex and ever-changing. Each patient will have different problems and unique requirements, making testing difficult in an environment not yet leveraged by healthcare workers.

It is important to test in the real world as much as possible to ensure data quality, including testing across different systems, platforms, and providers. By incorporating real-world data into your tests, you can better ensure the accuracy and quality of your results.

Fluffy Spider completes interoperability testing in healthcare

We develop integrated health solutions and integrated software systems for connected, interoperable digital healthcare. Our solutions manage the electronic health information journey from devices to the cloud and medical record systems.

We implement solutions in the cloud and the clinic to make health data secure and available when and where you need it. Our experienced team can bring together your devices, telehealth systems, EHRs and other patient management software to ensure each platform works together and delivers frictionless health.

High-quality commercial software requires a dedicated team with relevant experience. We can work with you through the entire process, from concept to commercialisation. Visit our Healthcare Integration Services page to learn more about our capabilities and solutions.