Imagine this: a pregnant woman arrives at the emergency room. She had an ultrasound last week. Her GP wrote a report. The midwife left detailed notes in a dedicated software. Yet nothing is accessible. Nothing connects. So they start all over again, often blindly.
Welcome to 21st-century French medicine, where information exists, but gets lost along the way.
At a time when we’re talking about artificial intelligence, personalized care, and proactive prevention, a paradox remains: the very systems designed to support healthcare professionals still operate as isolated silos. Software abounds, but they don’t speak to each other. And in this digital cacophony, professionals are exhausted, patients repeat their stories endlessly, and the system’s efficiency erodes.
What we call interoperability, the ability of systems to exchange data smoothly, securely, and meaningfully, is not a luxury. It’s a fundamental prerequisite for modern medicine. An invisible yet essential link in the care process.
This text dives into the flaws and promises of interoperability. It weaves together the voices of caregivers, patients, and institutions. It questions our digital sovereignty. And above all, it explores a disruptive path: that of a sovereign, open-source medical blockchain designed not to surveil, but to connect.
Because in the end, it’s not just about connecting machines. It’s about reweaving the threads of a fragmented care relationship. And asking one simple but pivotal question: who benefits from data when it doesn’t flow?
When caregiving becomes digital archaeology
In the daily life of doctors, there’s a silent form of exhaustion. Not the kind from long consultations or late-night emergencies. But the quiet fatigue of having to reconstruct, piece by piece, a fragmented medical puzzle scattered across a dozen non-communicating software platforms.
Whether GPs, hospital staff, or care coordinators in community health centers, they all share the same struggle: medical information exists, somewhere. But finding it means digging, copying and pasting, calling around, sometimes even redoing scans.
It’s as if, instead of treating patients, we were playing guessing games. This digital fragmentation has very real consequences:
- time stolen from care, just to switch between ten interfaces to recover a patient’s history or prescription;
- increased risk of error due to the lack of a complete clinical picture;
- hampered coordination, with professionals working blind;
- redundant tests, because earlier results are… missing.
What if systems worked for us, not the other way around?
Against this backdrop, an interoperable system, where software can communicate and data flows effortlessly, seems less like a technical feat and more like common sense.
Such a system, designed for and with healthcare professionals, would change the game:
- it would reclaim valuable medical time;
- it would enhance decision-making by offering a comprehensive view of the care journey;
- it would strengthen coordination by connecting caregivers around the patient;
- it would pave the way for more preventive medicine by making smart use of aggregated data.
At AP-HP, the implementation of the ORBIS system has allowed some doctors to save 45 minutes a day. That’s not just a tech victory, it’s a clinical one: more time to listen, explain, and support.
Doctors don’t want gadgets, they want helpful tools
But for this to work, digital tools must be designed from the ground up for clinical use.
Healthcare professionals aren’t asking for miracles, just tools that are simple, reliable, and well integrated. Their needs are clear:
- intuitive interfaces that don’t require a 200-page manual;
- seamless integration into workflows, with no unnecessary clicks or disruptions;
- clinically relevant data, not a flood of raw information;
- access that never fails, even in emergencies or on the move;
- and uncompromising respect for medical confidentiality.
When the patient becomes the messenger, unwillingly
We often picture the care pathway as a smooth line, a chain where each professional builds on the work of the last. But for many patients, it feels more like a scavenger hunt. At every step, they must repeat their story, carry test results, explain everything again, sometimes even prove that exams were done.
Welcome to a healthcare system that doesn’t listen to its own data.
In a world where our phones remember where we parked and what time our train leaves, patients still have to link their GP, specialist, pharmacist, and hospital manually. It’s 21st-century medicine… with 20th-century tools.
This interoperability failure isn’t just inconvenient, it creates chronic stress and fatigue:
- repeating the same info over and over without knowing if it’s been heard;
- acting as a go-between, hoping to remember everything;
- finding out your own medical data is inaccessible, scattered in systems that ignore you;
- never knowing who read what, or why.
A France Assos Santé survey found that 78% of patients had to repeat the same information to different caregivers, and 65% underwent duplicate exams. This isn’t redundancy, it’s digital silence.
Toward truly patient-centered care
What if systems worked for patients, instead of relying on them to hold everything together?
Patient-centered interoperability, grounded in real-life experience, would change everything:
- care would flow more coherently, with fewer gaps and repetitions;
- patients would gain real power: to consult, understand, and decide;
- errors from forgotten allergies or duplicate treatments could be avoided;
- paperwork would shrink, phone calls would decrease;
- participation in research would become easier and safer.
This is the early ambition behind the Mon espace santé project, a platform to store, share, and exchange health information. A seed of personal digital sovereignty. But it still needs to become a tool that’s truly used, and useful.
Patients want clarity, choice, and control
Ultimately, patients aren’t asking for a tech revolution, but a shift in perspective. They want to:
- choose who can access their data, and for how long;
- know when their data is viewed, and why;
- navigate interfaces that work even with cognitive or visual impairments;
- trust that their privacy is non-negotiable;
- carry their data like an expanded health card.
Marie Lefort, a patient association representative, sums it up: “We no longer want to be the delivery people for a disconnected system. We want to be partners in our own care.”
These fragmented paths don’t just frustrate patients, they also hide massive economic blind spots. Behind each redundant test, avoidable hospitalization, or delayed diagnosis lies a cost that could have been avoided. A cost that weighs on the entire system, its funders, and ultimately the public.
Patients bear the human burden of fragmentation, while insurers bear the financial one, without always having the tools to act. Two sides of the same coin, both would benefit from better data flow.
Health insurers: when data becomes a lever for transformation
Behind the spreadsheets of social security, mutual funds, and complementary insurers lies an untapped promise: better care through better understanding. But that requires data to circulate.
Today, health insurers, public or private, navigate seas of fragmented data. Information exists, but it’s siloed, redundant, incomplete. Like working on a puzzle with only one piece.
A two-tiered, two-siloed architecture
The French system relies on a dual structure: CNAM on one side, complementary insurers on the other. In between, digital walls that complicate everything:
- fragmented data prevents a holistic view of care;
- administrative processes are duplicated;
- economic analysis remains blurry without shared tools;
- innovation is slowed by inaccessible data vaults.
This lack of flow doesn’t just cost time, it costs money, energy, and delays progress in public health.
Opening the data streams to create value
Improving interoperability is not just about connecting systems, it’s about creating value at every level:
- understanding care pathways helps identify waste and redundancy;
- simplifying exchanges cuts admin costs;
- cross-checking data reveals inconsistencies, and sometimes fraud;
- analyzing trends improves prevention and anticipates complications;
- readable data fuels better, more personalized health offerings.
It’s a simple promise: act before care fails. Prevent, don’t just repair.
When small initiatives become weak signals of change
Some early efforts hint at a coming shift:
- the SNDS, a massive data reservoir managed by CNAM, offers panoramic insight into spending and care;
- universal third-party payment relies on rare but solid digital bridges;
- the Health Data Hub aims to enable secure data sharing for research, though its hosting sparked debate;
- SESAM-Vitale e-billing standardizes exchanges, a step toward greater coherence.
But these tools, still underused or siloed, struggle to scale. The ecosystem remains fragmented, sometimes out of inertia, sometimes out of caution.
What role will insurers play tomorrow?
Interoperability paves the way for a profound transformation of the role of health insurers. Instead of being mere payers, they could become:
- partners in prevention, capable of identifying risks before they turn into illnesses;
- architects of new economic models, focused on sustainable health rather than sheer volume of procedures;
- supporters of innovation, by facilitating access to data that fuels research;
- facilitators of care pathways, able to orchestrate fine-tuned coordination among professionals.
But for that to happen, systems need to open up. Trust must be built. And data must stop being guarded treasure and start becoming a shared resource, serving everyone.
Faced with this complex landscape of obstacles, hopes, and unfinished reforms, a pressing question arises: are we doomed to digital fragmentation, or are there already pathways we can follow out of it? France is neither the first nor the only country to face this challenge. Others have explored different approaches, some with a remarkable head start.
These are not just geographical curiosities. They are full-scale laboratories from which we can draw valuable lessons. What architectures did they choose? What governance models did they adopt? And above all, what aspects of their success could inspire us, without forcing us to copy-paste their solutions? Because looking elsewhere is not surrendering our uniqueness. It’s enriching our thinking with real-world experiences that have proven effective.
A look abroad: when systems finally talk
Interoperability isn’t utopian, it exists, it works, it saves time and lives. We only need to look abroad to see it.
In several countries, the question is no longer whether to interconnect systems, but how to go further. Here are some guiding stars for rethinking the French model.
Estonia: small country, big vision
Imagine a place where every citizen can access their health records, share them instantly with a doctor, track access logs, and revoke permissions. That place is Estonia.
- The X-Road infrastructure connects public and private databases through a unified, secure architecture.
- The national health record is centralized and accessible via digital ID.
- Cross-border prescriptions work: a doctor in Finland, a pharmacy in Estonia, it’s seamless.
- Patient consent isn’t optional, it’s a pillar. Users can see who accessed their data and block it at will.
This model didn’t happen by chance. It stems from political will, digital culture, and clear legal frameworks. The state chose to act as a digital architect, and it’s paying off.
Denmark: long-term coherence
Another European pioneer: Denmark. Since the 1990s, the country has steadily worked toward a connected health system.
- MedCom, an independent agency, defines data exchange standards;
- the Sundhed.dk portal lets citizens access their data, message providers, and manage appointments;
- the use of open standards ensures all systems, public or private, can interoperate.
The Danish secret? A pragmatic, progressive approach and ongoing dialogue between the state, professionals, and patients.
The United States: betting on standards
Long hindered by fragmentation, the U.S. made a strategic pivot with the development of FHIR (Fast Healthcare Interoperability Resources), a standard that changed everything.
- FHIR is based on modern web tech (REST, JSON), developer-friendly;
- it’s modular, extensible, universal, both simple and powerful;
- it’s spreading globally: over 50 countries use it, including major tech firms and French hospitals.
But FHIR didn’t gain traction alone. It was backed by legislation like the 21st Century Cures Act, which bans data lock-in and mandates open APIs.
Though market-driven, the U.S. approach shows how regulation and innovation can jointly boost interoperability.
The UK and Australia: striking other balances
In the UK, progress comes through gradual refinements:
- NHS Digital publishes the standards;
- the Summary Care Record ensures emergency access to key data;
- the NHS app gives patients mobile access to health info.
Australia tailors its strategy to its federal model:
- the My Health Record is national but regionalized;
- the Australian Digital Health Agency coordinates efforts;
- Australia was an early FHIR adopter.
These examples show that technical architecture must match political structures, but a shared foundation is possible.
Who owns our health data?
Looking at foreign models yields valuable technical and organizational insights. But it also creates a disturbing mirror effect: as we examine how other countries have built their digital sovereignty in healthcare, we can’t help but question our own.
These international comparisons highlight a French paradox: we have one of the richest health data assets in Europe, one of the strongest legal frameworks, and yet a significant portion of our digital medical infrastructure remains outside our direct control. Estonia built its system on a national architecture. Denmark relied on open standards under public governance. The United States mandated interoperability by law while letting the market innovate.
And us? Who are we really entrusting with our most intimate data? What technological, political, and strategic choices have we made, sometimes without public debate? Looking outward inevitably brings us back to a deeper question: what are we doing with our own data? And most importantly, are we truly in control of it?
Because in constantly admiring foreign successes, we risk forgetting that France already holds a vast treasure: millions of health records collected daily, some of the world’s most protective laws, and a network of public and private actors capable of innovating. And yet, this potential remains largely stifled.
Stifled by technological dependencies. By vague governance. By a lack of clarity about who controls what, and in whose interest. But health data sovereignty is not a rich country’s luxury, nor a technocratic obsession. It is a foundation. A prerequisite. A lever for autonomy.
Because without control over infrastructure, without oversight of data flows, without the ability to act on what happens to our data once it’s collected, we’re merely building castles in the sand, beautiful on the surface, but ready to collapse with the next geopolitical tide.
Now is the time to turn the mirror inward. Before copying others, we must first take stock. And ask, out loud: can our healthcare system remain independent if it relies on tools it does not own?
In the public imagination, health data evokes neatly filed records, locked away in hospital safes or stored in the cloud of a trusted public institution. But in reality, data travels. It crosses servers, borders, sometimes without anyone, not even the patient, being aware.
The unsettling question is a simple one: who controls these invisible flows? And above all, who really owns our health data?
Data sovereignty: much more than a matter of geography
It’s tempting to think that hosting data in France is enough to ensure peace of mind. But sovereignty isn’t about IP addresses. It’s about laws, technical dependencies, power dynamics. It’s about control.
Having a copy of your data doesn’t mean mastering it. What matters is the ability to decide how it’s used: who can access it, for what purpose, and under what conditions. Yet the moment data flows through technologies designed abroad, or hosted by actors subject to foreign laws, that power slips away from us.
Our health data is more than confidential. It reveals our vulnerabilities, our weaknesses, our therapeutic hopes. It is also a highly coveted resource, by researchers, insurers, and industry. And sometimes, it’s traded without our knowledge.
It’s valuable because it enables innovation, treatment, and prediction. But the line between good intentions and opportunistic use is thin.
And what’s at stake is not just our privacy. It’s our ability to maintain control over an entire sector of our healthcare system.
A legal fortress… with occasionally porous walls
France, backed by the European Union, has built a solid regulatory framework: GDPR, the Data Protection Act, HDS certification, and more. On paper, our data is among the best protected in the world.
But in practice, cracks remain.
The Health Data Hub, hosted by Microsoft, became a flashpoint. Why entrust the data of millions of French patients to an American company subject to the Cloud Act? This decision was challenged in court, but above all, it exposed a deeper discomfort: our technological dependence.
Because as long as we lack the means to store, process, and secure our data independently, any claim to sovereignty remains relative.
Taking back control: a technical and cultural undertaking
In the face of these challenges, solutions do exist. Some are already well known:
- localized, certified servers insulated from foreign jurisdictions;
- strong encryption systems, reinforced authentication, regular audits;
- cybersecurity training for professionals, and a real data culture among citizens.
But this isn’t just an engineering issue. It’s also a political one.
Because building a sovereign cloud, supporting French and European alternatives, and fostering alliances between public and private actors all require determination. And above all, a clear vision.
Building a resilient, European ecosystem
This challenge cannot be addressed by France alone. It must be part of a broader European framework. Initiatives like GAIA-X, the European Health Data Space, and EU-wide cybersecurity certifications, if properly supported, could give rise to a third path, between American dependence and isolationism.
But this requires breaking free from the logic of technological minimalism. Choosing control over convenience. Security over speed. Long-term resilience over plug-and-play solutions.
And this shift will only succeed if accompanied by a widespread upskilling of all stakeholders: healthcare professionals, patients, decision-makers.
Because protecting data isn’t just the job of IT experts. It’s a culture to promote, a vigilance to maintain, a responsibility to share.
Otherwise, we risk becoming digital tenants of our own lives.
How about moving from discussion to action, starting now?
What we’ve explored here goes far beyond technology. It’s not just about making software communicate or harmonizing data formats. Interoperability in medical information systems is about stitching back together a healthcare fabric often torn apart, restoring coherence to a fragmented system, and putting people back at the heart of digital health.
For doctors, it holds a simple promise: freeing them from poorly designed interfaces, and giving back medical time, connection, and meaning. The ORBIS example at AP-HP shows that well-designed interoperability is not an engineer’s dream, it’s a tangible improvement in the care relationship.
For patients, it offers hope for a smoother, fairer, more respectful journey. A world where they no longer have to repeat the same story a hundred times. Where they can easily access their own data. Where they become active participants, not passive observers, in their care.
For health insurers, it’s an opportunity to move beyond the passive role of payer, and become partners in care, prevention, and innovation. A quiet transformation, but a decisive one.
And for the nation, it’s a matter of sovereignty. In a world where data has become the new raw material of healthcare, relying on foreign technologies means risking a loss of health autonomy. It’s no longer about simply storing data locally, but about full-spectrum mastery, legal, technical, and strategic.
Foreign models, Estonia, Denmark, the United States, show us that pathways exist. But none can be copied as-is. France must carve out its own, at the crossroads of its medical culture, institutions, and democratic values.
Despite their differences, these models share a common foundation:
- clear governance, with defined roles for each stakeholder;
- open standards, accessible and shared;
- a patient-centered approach, with transparency and control;
- an adapted legal framework, protective without being obstructive;
- continuous investment in infrastructure and skills.
So where does France stand?
It is moving forward, but unevenly. The talent is there. The tools are there. The institutions are in place. What’s still missing is a unifying vision and a shared commitment. Without that, interoperability will remain a technical goal, not a lived reality.
A personal conviction to conclude
Over the years I’ve spent researching interoperability, I’ve come to a deep conviction: the future of our healthcare system depends on a subtle alliance between humanity and technology. Not a technology that replaces, but an intelligence that amplifies.
It is with this spirit that our team is currently developing DOCTORIAA, a solution of augmented intelligence designed to support medicine. This approach puts the physician at the heart of the decision-making process, while providing analytical tools that enhance clinical practice without disrupting it. The philosophy is clear: the doctor remains in full control of their usual clinical protocol, while the system quietly analyzes available data to suggest complementary avenues.
DOCTORIAA’s innovation also lies in its technical architecture, designed with interoperability in mind. By flipping the traditional model, we’ve created an “API-first” system, where the programming interface is the core of the platform. This open, partially open-source approach allows other medical applications to connect seamlessly, building an extensible ecosystem rather than yet another silo.
Faced with the challenge of medical deserts, such solutions could also help maintain consistent quality of care across the country, enabling remote consultations supported by augmented intelligence, without ever replacing human clinical judgment.
Data security and sovereignty are also embedded by design, with secure local storage mechanisms ensuring that patients’ sensitive information remains under control, within the environment of the doctor or the healthcare facility.
I strongly believe that this kind of approach, ethically grounded, human-centered, is how we can begin to solve some of the pressing challenges in our healthcare system.
Just imagine: an on-call doctor in the emergency room, facing an unconscious patient they know nothing about. Today, they have to guess, assume, fumble. Tomorrow, with a simple gesture, they could access her full, secure, coherent medical history. The difference? A few minutes, perhaps. The cost of those minutes? Sometimes, a life.
Interoperability isn’t a high-tech luxury reserved for digital insiders. It’s the invisible thread that connects knowledge to action, past medical history to present care, the system to the individuals it’s meant to serve.
In the end, behind every medical record that doesn’t circulate, a bit of our collective humanity is lost to the digital void.
Our health deserves better than systems that turn their backs on each other. It deserves bridges, not walls.