The biggest hurdle i face with interoperability is getting people to buy into the standard. working with (https://www.hl7.org/fhir/R4/)[FHIR] it seems like 90% of the objection is that the standard is to use unstructured json to request/respond. To many out there it feels like this is a completely foregin concept. I even have some staff engineers balk at the idea of using FHIR because its not going to conform to any ORM package. As this article says with standards comes maintenance and this is why the FHIR spec is constantly evovling with new versions and updates and even the ability to create your own implementation guide.

It is the standard in healthcare though. The world is using it to exchange data for both payor and clinical. The US has mandated the use of it for healthcare. Its built into Apple and Samsung Health apps. You can get your entire FHIR chart via mychart (epic) instances (along with many other EHR systems). And yet I'm having to prove out why we shouldnt use custom structured ORM models to translate in/back because many have grown so accustomed to it.