Bridging IT Systems and Interoperability in Healthcare: ZIBs and FHIR

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Modern healthcare IT systems—such as EHRs and lab systems—are designed for specific processes and hold vast amounts of data. However, many operate within a closed 'black box' architecture. This results in data fragmentation across departments and systems. Beyond mere incompatibility between different vendors, there is also a lack of semantic interoperability, meaning even if systems can technically communicate, they may not correctly interpret each other's data. This forces healthcare professionals and researchers to spend significant time manually transcribing and translating data, increasing the risk of errors and reducing efficiency. To address this, the article proposes using 'Zorginformatiebouwstenen (ZIBs),' which are standardized data structures. ZIBs allow medical information—such as diagnoses or medication usage—to be defined and structured uniformly, independent of the specific IT system where it originated. This standardized data can then be converted into HL7 FHIR resources, making them broadly accessible via APIs. This open ecosystem enables secondary applications beyond primary care use, including: automated collection for quality indicators (benchmarking), large-scale research on disease patterns and AI model training using standardized datasets, and secure international patient data exchange through the European Health Data Space (EHDS). Crucially, interoperability requires understanding the 'context' of the data. By linking data to specific care trajectories or episodes, ZIBs and FHIR ensure that a coherent patient picture is maintained across different providers. This improves continuity of care, reduces duplicate registration, and supports network care among hospitals, general practitioners, and other providers.