Why healthcare’s next interoperability investment is talent
FHIR adoption is accelerating, but the workforce needed to implement, govern and sustain it is not scaling at the same pace.
Healthcare has spent decades building the standards, infrastructure and policy frameworks required to make health data more interoperable. As that work moves from adoption to implementation at scale, the industry is confronting a different challenge: having enough people who know how to make interoperability work in real clinical, operational and technical environments.
An internal workforce-demand model I developed for HL7 International estimates that global demand for HL7 FHIR-skilled practitioner-equivalent roles could grow from about 120,000 today to 420,000 by 2031, while an additional 1.1 million people working in product management, clinical informatics, data, security, procurement, policy and digital transformation may need meaningful FHIR literacy. These are planning estimates rather than a census or precise prediction, but they illustrate the potential scale of the capability gap.
A second signal comes from the 2026 State of FHIR report produced by HL7 International and Firely. The survey of 101 interoperability experts across 63 countries found that 75% identified a lack of FHIR knowledge as a barrier to adoption, making it the most commonly cited challenge for the fourth consecutive year.
Demand is expanding faster than the talent pool
The workforce challenge is being driven in part by interoperability's success. In the United States, CMS requirements call for impacted payers to implement or enhance several FHIR-based APIs beginning January 1, 2027, including provider access, payer-to-payer exchange and prior authorization capabilities. In Europe, the EHDS regulation begins major phased implementation in 2029, with additional priority health-data categories following in 2031.
As interoperability becomes embedded in national health infrastructure, the expertise required to support it spreads far beyond the teams that write standards or build APIs. Health systems need people who understand integration and workflow, vendors need implementation and conformance expertise, governments need professionals who can develop specifications and governance frameworks, and organizations deploying AI need people who understand how data quality, provenance, terminology and interoperability affect those systems.
The skills themselves are becoming more sophisticated as implementation matures. Basic familiarity with FHIR will not be enough for many organizations; they will need deeper expertise in implementation engineering, terminology and semantic interoperability, security and identity, conformance testing, legacy transformation, architecture, governance and lifecycle management.
We cannot hire our way out of this
When organizations encounter a skills shortage, the instinct is often to compete for the people who already possess the expertise. That may solve an immediate vacancy, but it does not solve an industry-wide capacity problem when many employers are drawing from the same limited pool.
The HL7 workforce model suggests that the base case could require approximately 300,000 additional core practitioner-equivalent roles between 2026 and 2031. After accounting for people changing roles, leaving the workforce and skills becoming outdated, approximately 350,000 to 450,000 people may need to become newly capable at the practitioner level over five years; across core and adjacent roles, the potential education and upskilling need could reach 1 million to 1.5 million people.
There is not a ready-made pool of hundreds of thousands of experienced interoperability professionals waiting to be recruited. Workforce development therefore needs to happen on two fronts at once: developing the next generation of interoperability professionals while expanding the skills of people already working across healthcare, technology and informatics.
Build the pipeline earlier
One of the industry's greatest opportunities is to make interoperability a more visible career pathway. Young people interested in technology are introduced relatively early to fields such as cybersecurity, software engineering, data science and AI, while healthcare interoperability is rarely presented with the same visibility despite the technological and societal challenges it addresses.
Stronger pathways through universities, technical programs and early-career education can expose students to interoperability before they have already chosen another direction. Programs such as HL7's Break the Code, developed with the Commission on Accreditation for Health Informatics and Information Management Education, are designed to introduce students to FHIR through practical application-building rather than specifications alone. The objective should be to show people what interoperability makes possible and give them a credible pathway into the field.
Universities alone, however, cannot meet the scale of the need. Healthcare also needs a much broader approach to continuing education because not everyone who works around interoperable data needs to become a FHIR engineer, and the appropriate depth of knowledge varies substantially by role.
Our workforce model therefore distinguishes between core practitioners who design, implement, profile, test, secure or govern FHIR solutions and a much larger adjacent workforce that needs enough understanding to make informed decisions about products, workflows, data quality, consent and compliance. That distinction should shape how organizations design education, credentials and career pathways rather than relying on a single generic training course.
Make talent part of the interoperability strategy
For CIOs, workforce development can no longer sit apart from interoperability strategy. Organizations planning major FHIR implementations should assess not only their technical architecture but also the capabilities required to operate and sustain it, including where deep expertise must reside internally, which skills can be supported through partners and which existing employees can be upskilled.
The answer will look different for every organization, and a health system does not need every employee who touches interoperable data to understand how to build an implementation guide or debug a FHIR server. It may, however, need people across clinical informatics, security, procurement, operations and digital transformation who understand how interoperability affects their work and know when specialist expertise is required.
That requires moving beyond a single generic 'FHIR training' course toward a more deliberate learning architecture. Organizations can distinguish among foundational literacy, practitioner-level implementation skills, advanced expertise, national implementation-guide specialization and role-specific education, then connect those levels to workforce plans and career pathways.
The infrastructure is only as strong as the people behind it
Healthcare interoperability has reached an important inflection point. Standards are increasingly mature, adoption is expanding, governments are incorporating interoperability into national healthcare infrastructure, and technologies such as AI are making access to trusted, exchangeable data even more important.
That progress creates a new responsibility for healthcare leaders. Building infrastructure is not enough if the industry does not also build the human capability required to implement, operate, govern and sustain it; the next generation of interoperability will depend on engineers and architects as well as clinicians, informaticians, security professionals, product leaders, policymakers, testers and operational teams.
Healthcare has spent years building the standards that allow systems to speak the same language. The next task is making sure there are enough people who know how to turn that capability into better healthcare, and enough organizations willing to treat that talent as core infrastructure rather than an afterthought.
Prof. Rachel Dunscombe is chief executive officer of HL7 International, where she leads global efforts to advance interoperability and standards that enable scalable, data-driven healthcare.