When the Law Meets the API: How FHIR Is Reshaping Health Data Interoperability in Israel

For years, healthcare interoperability has been framed as a technical problem.
If systems could just “talk to each other,” the thinking went, data would flow, care would improve, and patients would finally gain control over their medical records.

Reality has been more complicated.

In Israel, a new approach is quietly taking shape, one that treats interoperability not only as an engineering challenge, but as a legal and civic obligation. At the center of this effort sits a technical standard with an unassuming name: FHIR.

A Legal Push to Unlock Patient Data

Israel’s interoperability framework is built on a clear policy goal: to give individuals a practical right to port their medical information, rather than leaving data locked inside institutional systems.

Under the law, health organizations are required to make patient data portable, transferable, and accessible, subject to patient consent. Transfers must be possible without conditioning access on commercial agreements or imposing unnecessary friction on the patient. Medical information should be able to move with the person across providers, digital services, and care settings.

This represents a shift from voluntary cooperation to mandated interoperability, enforced through regulation rather than goodwill.

Importantly, the framework is being rolled out in phases. While the law is already in force, many of its operational provisions are scheduled to take effect over the coming years, with full implementation expected later in the decade.

But legislation alone does not move bytes. For that, the law needs a technical backbone.

Why FHIR Was Chosen

FHIR (Fast Healthcare Interoperability Resources) was designed to address a long-standing problem in healthcare IT: the absence of a shared, modern language for clinical data.

Unlike older standards, FHIR relies on familiar web concepts such as APIs, structured resources, and machine-readable formats. Each clinical concept, a patient, an observation, a medication, or a prescription, is represented as a discrete, well-defined object that systems can exchange predictably.

For policymakers, this matters. A legal right to data portability is meaningless if every system exports information in a different, incompatible format. FHIR provides a common grammar that allows laws about access, consent, and portability to be implemented in practice.

In Israel, FHIR has become the reference model for how patient data should be exposed, shared, and consumed across systems, supported by a national certification and interoperability program led by the Ministry of Health.

Medication Data: Where Interoperability Is Tested

Few data domains reveal the limits of interoperability as clearly as medications.

At first glance, medication data appears straightforward: a drug name, a dose, a frequency. In practice, it is anything but. Formulations differ. Strengths vary. Local drug catalogs rely on inconsistent identifiers. Clinical intent is often encoded in free text.

FHIR brings structure to this complexity by separating distinct concepts:

• the medication itself
• the clinician’s intent to prescribe
• the act of dispensing
• the record of administration

This separation allows systems to exchange medication-related information with far greater precision than legacy formats.

But structure alone does not guarantee correctness.

The Limits of Standards Alone

One of the most common misconceptions about FHIR is that it “solves” interoperability.

It does not.

FHIR defines how data is represented and transported, but not which data must be present, nor how consistently it is populated. Two systems can both be FHIR-compliant and still disagree on something as fundamental as what constitutes the “same” medication.

This is where governance, certification, and enforcement become as important as the standard itself. Israel’s approach explicitly acknowledges this by pairing FHIR adoption with validation requirements, national profiles, and oversight mechanisms that constrain how the standard is used.

In this model, interoperability is not just a format.
It is a discipline.

When Policy and Engineering Align

What makes Israel’s framework notable is not the choice of FHIR itself, but the way law and technology reinforce one another.

The law creates obligations:

• data must be portable
• consent must be respected
• access cannot be arbitrarily restricted

FHIR provides the technical means to fulfill those obligations in a consistent, auditable way.

Neither would be sufficient on its own.

This alignment reflects a broader global shift. In the United States, similar dynamics are visible through the 21st Century Cures Act and its interoperability and information-blocking rules. In Europe, the emerging European Health Data Space points in the same direction.

Interoperability is becoming something governments mandate, not something vendors optionally support.

What This Means for Patients and Providers

For patients, the implications are subtle but significant. When interoperability works, it is largely invisible. Information follows the individual. Medication histories are more complete. Transitions of care involve fewer gaps.

For providers and systems, the change is more tangible. Interoperability moves from being a strategic differentiator to a baseline expectation. Compliance is no longer about ticking boxes. It becomes part of core system architecture.

FHIR, in this context, is less a breakthrough than a foundation.

Interoperability as Public Infrastructure

The lesson emerging from Israel’s experience is straightforward: interoperability does not happen by accident.

It requires:

• legal clarity around data portability and consent
• technical standards that can be implemented at scale
• governance that ensures consistency over time

FHIR makes interoperability possible.
Law makes it unavoidable.

As healthcare systems around the world grapple with fragmented data and rising patient expectations, the intersection of policy and technology, rather than either in isolation, may prove to be the real engine of change.

In healthcare, it turns out, APIs are only as powerful as the laws that compel their use.

→ Read the Israeli interoperability law (Hebrew)