When the Health is Digital and Care is Borderless: The Role of International Standards in Health Data

In today’s rapidly evolving healthcare landscape, where AI can detect disease before symptoms appear, and patient care crosses borders with a video call, health data has become both a lifeline and a liability. Every heartbeat tracked by a smartwatch, every image from a digital scan, and every line of a patient record tells a story, but only if we understand it the same way.

This is where international health data standards step in. They’re the foundation behind interoperability, privacy, safety, and quality care. Without them, the promises of AI-driven diagnostics, precision medicine, and global telehealth would collapse under confusion and chaos. While they rarely make headlines, these standards form the invisible infrastructure of the digital health revolution.

Why Standards Matter: More Than Just Tech

When a cardiologist in Nairobi reviews an echocardiogram uploaded in Toronto, or when AI models trained in the U.S. are applied to patient data from Sri Lanka, there must be a shared vocabulary and framework. Otherwise, errors, misinterpretations, or data loss become a dangerous challenge.

International standards are the foundation of semantic interoperability, which not only transfers data but also preserves its meaning. They enable accurate clinical decisions, ensure patient safety, and support the secure, ethical exchange of health information.

The Big Players: Who Sets These Standards?

Several organizations play key roles in shaping the language, format, and security of health data across the world. Each focuses on different aspects of data exchange and harmonization.

HL7 and FHIR (Fast Healthcare Interoperability Resources)

Health Level Seven International (HL7) is the organization behind FHIR, a standard that uses modern web technologies to enable fast and scalable health data exchange. It’s widely adopted by EHR vendors and mobile health app developers, and forms the backbone of many clinical interoperability projects (Bender & Sartipi, 2013).

SNOMED International

SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms), maintained by SNOMED International, is the most comprehensive, multilingual clinical terminology globally. It allows for detailed, precise recording of symptoms, diagnoses, procedures, and outcomes. Used in over 40 countries, it’s central to semantic interoperability and supports data analytics, AI, and population health surveillance (Donnelly, 2006).

Regenstrief Institute and LOINC

LOINC (Logical Observation Identifiers Names and Codes), developed and maintained by the Regenstrief Institute, is the global standard for identifying medical tests, observations, and measurements. It enables consistency in lab test results, vital signs, and clinical assessments across systems and borders (Vreeman et al., 2010). LOINC and SNOMED CT are increasingly integrated to improve semantic precision.

ISO/IEC (International Organization for Standardization)

ISO publishes numerous standards relevant to health informatics, including ISO/IEC 27799, which outlines best practices for information security management in healthcare environments. These standards align with global privacy regulations and offer comprehensive guidance on data confidentiality, availability, and integrity (ISO/IEC 27799:2016).

IHE (Integrating the Healthcare Enterprise)

IHE develops implementation guides ("profiles") that combine existing standards like HL7, DICOM, and SNOMED CT to solve real-world interoperability challenges in hospitals and health systems (IHE, 2023).

WHO-ITU Digital Health Framework

The World Health Organization (WHO) and the International Telecommunication Union (ITU) co-developed a framework to guide countries in developing coherent digital health strategies rooted in global standards, ensuring equity and consistency in data handling (WHO-ITU, 2020).

Security, Ethics, and the Human Element

Standards are more than technical tools; they’re ethical commitments. Health data carries sensitive personal information. International standards such as ISO 27799 and privacy laws like GDPR and HIPAA mandate strict protocols for consent, data minimization, access controls, and encryption.

Moreover, these standards uphold patient autonomy and data dignity, ensuring people have control over their information, regardless of geography or technology platform.

Interoperability in Action

Standards demonstrate their complete value when applied internationally and across systems:

• FHIR and SMART Apps: Hospitals like Mayo Clinic and Boston Children’s have deployed SMART on FHIR apps that integrate seamlessly with EHRs, offering real-time decision support while preserving data privacy (Mandl et al., 2012).
• LOINC in Pandemic Surveillance: During the COVID-19 pandemic, LOINC codes were crucial for standardized reporting of test results and epidemiological data, enabling global tracking and response coordination (CDC, 2020).
• SNOMED CT in AI Development: Structured terminologies like SNOMED CT have been used to annotate training data for machine learning models, improving accuracy in clinical NLP and decision support systems (Wang et al., 2021).
• International Health Exchange: The EU’s eHealth Digital Service Infrastructure (eHDSI) uses SNOMED CT and LOINC to allow patients traveling within Europe to share prescriptions and health summaries across national health systems (European Commission, 2022).

The Challenges Ahead

Despite their importance, the adoption and harmonization of international standards still face hurdles:

• Uneven Adoption: Many low- and middle-income countries lack the infrastructure, funding, or training to implement these standards effectively.
• Versioning Conflicts: Variations in standard versions used across systems can cause data mismatches.
• Proprietary Systems: Vendor lock-in and lack of open APIs often prevent seamless interoperability.
• Semantic Drift: Even with standards, clinical meanings can subtly differ across regions or specialities without strict governance.

However, global efforts like Global Initiative on Digital Health (GIDH), Global Digital Health Partnership (GDHP), Digital Square, the Global Digital Health Partnership, and open initiatives from SNOMED and LOINC aim to close these gaps.

Final Thoughts: A Trust Contract

Every click of an EHR dashboard, every ED triage, every AI-predicted cancer risk, rely on standards most users never see. These standards are not just about data, they’re about trust. They are the silent, shared contract that allows technology to work safely, ethically, and globally.

In a world where health is digital and care is borderless, international standards are our common ground. They don’t just connect machines, they connect people, ideas, and care.

References

1. Bender, D., & Sartipi, K. (2013). HL7 FHIR: An Agile and RESTful approach to healthcare information exchange. Proceedings of the 26th IEEE International Symposium on Computer-Based Medical Systems, 326–331. https://doi.org/10.1109/CBMS.2013.6627810
2. Donnelly, K. (2006). SNOMED-CT: The advanced terminology and coding system for eHealth. Studies in Health Technology and Informatics, 121, 279–290. https://doi.org/10.3233/978-1-58603-648-6-279
3. Vreeman, D. J., McDonald, C. J., & Huff, S. M. (2010). LOINC®: A universal standard for identifying laboratory observations. Journal of the American Medical Informatics Association, 17(5), 435–440. https://doi.org/10.1136/jamia.2010.004085
4. ISO/IEC 27799:2016. Health informatics — Information security management in health using ISO/IEC 27002. International Organization for Standardization.
5. IHE. (2023). Profiles. Integrating the Healthcare Enterprise. https://www.ihe.net/resources/profiles/
6. WHO-ITU. (2020). WHO-ITU National eHealth Strategy Toolkit. World Health Organization & International Telecommunication Union.
7. Mandl, K. D., Mandel, J. C., & Kohane, I. S. (2012). Driving innovation in health systems through an apps-based information economy. Cell Systems, 8(1), 33–39. https://doi.org/10.1016/j.cels.2018.12.002
8. Wang, Y., Wang, L., Rastegar-Mojarad, M., et al. (2021). Clinical information extraction applications: a literature review. Journal of Biomedical Informatics, 109, 103526. https://doi.org/10.1016/j.jbi.2020.103526
9. European Commission. (2022). eHealth Digital Service Infrastructure (eHDSI). https://health.ec.europa.eu/ehealth-digital-service-infrastructure
10. Centers for Disease Control and Prevention (CDC). (2020). COVID-19 LOINC In Vitro Diagnostic (IVD) Test Code Mapping. https://www.cdc.gov/csels/dls/loinc-mapping.html