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(Originally published as a Firely blog post)

Developed from years of real-world experience, these rules provide crucial insights for anyone working on FHIR projects to help make better decisions and increase your chances of long-term success. Here's a breakdown of Lloyd's six interoperability rules-and an opportunity to contribute your own.

The 6 Rules of Interoperability

1. Postel's Law

'Be conservative in what you do, be liberal in what you accept from others'. In other words, be careful to send out data that is compliant but be flexible when receiving data from others to maximize interoperability.

2. The 80% Rule

FHIR specifications should only include elements and features that most systems (80%) have the capability of handling, ensuring that standards remain broadly usable. Not to be confused with the Pareto Principle-20% of effort brings 80% of benefits.

3. Fast, Interoperable, Cheap-Pick Two

In any project, you can't have all three-there will always be trade-offs. Understanding these constraints helps teams make better strategic decisions about what you can achieve with a particular set of resources for a project.

4. Tesler's Law (aka Law of Conservation of Complexity)

No matter how well-designed a system is, some level of complexity will always exist. As Grahame Grieve, the father of FHIR, suggests, TAG_BODYamp;You can move complexity around, but you can't make it go away.TAG_BODYamp; The key question is: where should that complexity live?

5. Grahame's Postulate

TAG_BODYamp;Interoperability is primarily a people problem, not a technical problem.TAG_BODYamp; The most elegant technical solution means nothing if the people implementing it aren't aligned and on board. Consensus, collaboration, and shared commitment are essential for advancing interoperability.

6. Richel's Rule

TAG_BODYamp;If you change the consensus group, you change the consensus.TAG_BODYamp; If a small group makes a decision, but the broader community doesn't agree, the effort will fail. When making decisions about interoperability, ensure that key stakeholders that you need buy-in from are involved early in decision-making to avoid costly rework later.

Key Takeaways

Lloyd McKenzie concluded his talk with several big-picture insights about interoperability and standards development:

• Words of wisdom and best practices are easy to throw around, but their true impact comes from carefully considering how they apply to real-world implementations.
• A long-term perspective is essential-rather than focusing only on immediate deadlines, organizations should think strategically about where and how they want to drive interoperability in the future.
• Stakeholder engagement is crucial-having the right people involved early in the process ensures smoother adoption and alignment. Interoperability standards take time to develop-progress may be slow, but true interoperability requires moving the entire healthcare community forward, not just the technology itself.

-Rene

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Index of columns:

• EHDS Governance Models (May 06, 2026)
• Get ready for EHDS implementation - EHDS-on-FHIR training course (Apr 10, 2026)
• EHDS will have an impact well before 2029 (Feb 13, 2026)
• EHDS checklist for application vendors and provider organizations (Nov 11, 2025)
• New EHDS-on-FHIR training course (Oct 26, 2025)
• Gender Identity in Interoperability Standards (Aug 25, 2025)
• FHIR and Narrative content (Jun 11, 2025)
• 6 Rules for Successful Interoperability Projects (Feb 13, 2025)
• Deploying FHIR at Scale (Dec 18, 2024)
• 9 Key Problems When Connecting to 400+ Servers (Sep 25, 2024)
• FHIR for HL7v2 experts (Aug 18, 2023)
• The FHIR open license (Feb 18, 2022)
• Bye bye IHE XDS and CDA. (Sep 01, 2021)
• Combining the best of IHE XDS with HL7 FHIR (Jun 27, 2019)
• FHIR DevDays and the year in review (Dec 27, 2018)
• Creation and Curation of FHIR Profiles - process and governance (Dec 14, 2017)
• Impact of the GDPR on the use of interoperability standards (Jun 27, 2017)
• Next XDS Release (Oct 27, 2016)
• Five years of FHIR (Aug 11, 2016)
• Update from the trenches on CDA R2.1/R3 and HL7v2. (Oct 15, 2015)
• Most often implemented IHE Profiles (Jun 08, 2015)
• Mapping HL7v2 messages to FHIR. (Apr 13, 2015)
• Recent and Future developments of the DICOM standard (Mar 06, 2014)
• Documenting the history of HL7 (Sep 03, 2013)
• Interoperability Standards - the no-sales pitch (Jul 09, 2013)
• CDA Implementation Guides - (not) invented here (Apr 17, 2013)
• Usage of IHE Profiles (Feb 25, 2013)
• 10 year anniversary - Dutch Ringholm HL7 v2 training courses. (Feb 19, 2013)
• HL7 Connectathons (Sep 09, 2012)
• Frequency of use of HL7 message types (Jul 24, 2012)
• Reflections on the HL7 membership model - the affiliate life cycle (Dec 28, 2011)
• RFH (Resources for Health): HL7 version 3 taken to the next step (Aug 18, 2011)
• Timezone Hotel (Mar 29, 2011)
• The changing role of HL7 country organizations (Jul 16, 2010)
• How to lower the hurdle for HL7 v3 implementers (Jan 21, 2010)
• The HL7 roadmap for CDA R3 and the CCD (Jan 17, 2009)
• HL7 based Tree inventory system (Jan 30, 2007)
• Workflow Bribery (Sep 15, 2006)

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Ringholm bv is a group of European experts in the field of messaging standards and systems integration in healthcare IT. We provide the industry's most advanced training courses and consulting on healthcare information exchange standards.
See https://www.ringholm.com for additional information.