Interoperability is critical: preparing for the next pandemic now

COVID-19 highlighted the lack of interoperability in our health systems. Here’s how ETL (Extract, Transform, Load) networks could help prepare for the next pandemic.

When the COVID-19 pandemic hit in 2020, a meme stating it was a ‘one in a hundred-year’ pandemic went viral, but in fact, there have been five pandemics in the last 60 years¹:

• 1957 — Asian Flu
• 1968 — Hong Kong Flu
• 1981 — AIDS/HIV
• 2009 — Swine Flu
• 2020 — COVID-19
   

That’s roughly one every 12 years, so it’s not going to be another 100 years before the next pandemic. Infectious disease specialists agree it’s probably not even going to be 12 years, because conditions for pandemics are improving — global warming, deforestation, high-density urbanisation and increasing global travel are allowing disease agents to spread more easily than ever before.

COVID-19 infected more than 780 million people worldwide and caused more than seven million deaths.² It highlighted the lack of interoperability in our health systems, with the associated lack of real-time, meaningful data leading to inconsistent decision-making, health inequities, economic disruption and social disorder.

We need to prepare for the next pandemic by unifying our healthcare information systems so we have timely, accurate data to inform government decisions.

COVID-19 in Australia

Our governments never had a chance to get ahead of COVID-19. The disparate nature of pathology services in Australia, with a mixture of public and private laboratories, using vastly different and disconnected information systems, made the collection and collation of daily test results impossible to achieve in a timely manner.

Testing volumes in Australia increased to a peak of 450,000 a week nationwide,³ putting enormous pressure on laboratory staff to scale their processes to match demand.

Reporting results to Australia’s health authorities was also a nightmare — staff had the mammoth task of manually transcribing and consolidating paper records of results, from different LIMS systems, with different test names, codes and formats, and with the added problem that data was often missing or wrongly transcribed.

It took many days to complete these tasks, meaning the government was always on the back foot in trying to manage the spread of the pandemic.

Across the country, people were saying if only we had health interoperability… But we didn’t — despite the fact this kind of interoperability is available.

Interoperability we can have now

Governments around the world have focused on achieving healthcare interoperability by designing, legislating and incentivising organisations to adopt data and communication standards.

The USA implemented the 21st Century Cures Act in 2016,⁴ which prohibited information-blocking and mandated standardised data sharing.

Here in Australia, the federal government committed $11.1 million from 2023 to 2025 for CSIRO to oversee the development and adoption of national FHIR⁵ standards for healthcare data exchange. An independent report by Voronoi in 2025⁶ noted the standards developed to date are “fit-for-purpose” but adoption is slow due to the lack of incentives for change.

The UK took a faster approach — a data translation service, that converts disparate data through ETL (Extract, Transform, Load) procedures to facilitate fast data sharing, analysis and decision-making.

ETL means there’s no need to agree to new naming conventions, interoperability or messaging standards, or make significant changes to existing systems.

ETL networks also streamline connectivity by replacing multiple point to point uni-directional interfaces with a single bi-directional interface to a hub, reducing the complexity of setting up and managing a distributed environment, eliminating manual tasks and freeing up IT staff to focus on more strategic and complex projects.

Implementation is fast because mapping only needs to be done once to the central hub, rather than every partner organisation. New advancements in AI are reducing the mapping process from weeks to mere hours.

Being cloud hosted, ETL services can be easily scaled and are highly secure, with all the security tools and capabilities that AWS, Microsoft Azure and other hosting platforms provide.

ETL services solve the interoperability problem by working with the differences in IT systems, rather than trying to standardise them. They manage the complexity of interoperability, allowing organisations to continue using the systems they have, while immediately increasing efficiency and fully leveraging their data for analysis and insight generation.

This is especially important during the crisis of a pandemic.

The Optimising Coronavirus Testing Systems (OCTS) project led by Michael Hopkins, University of Sussex, found that high-capacity, responsive Test, Trace and Isolate (TTI)⁷ systems that enable testing services to be scaled for extremely high volumes, can prevent deaths in a pandemic. This research showed that in an average week during 2020–2022, each additional 5000 COVID tests that were able to be performed, saved one life.⁸

The UK was fortunate that it had a pathology ETL network established when COVID-19 hit and NHS X Chief Clinical Information Officer Dr Simon Eccles quickly mandated its use for those laboratories not already using it “to achieve the interoperability required to defend the nation against COVID”.⁹ Forty-one laboratories were onboarded in just six weeks to give UK authorities real-time access to >95% of results.

That head start on interoperability was crucial to the UK being able to get real-time information on COVID test results it needed, to make timely and informed pandemic decisions.

There’s also a lot of operational benefits that could be realised by taking an ETL approach now — reductions in paper, manual data entry, duplication, transcription errors and patient risk, all of which lead to better resource utilisation, increased throughput, faster turnaround times and improved patient outcomes.

The economic benefits of health information exchange interoperability for Australia were modelled in 2007 with Level 4 interoperability benefits estimated at $2990 million — of which laboratory benefits account for 39%, or $1180 million,¹⁰ each and every year post implementation.

Summary

Recent concerns about the Nipah virus¹¹ are a timely reminder that another pandemic is inevitable.

In order to be ready for the next pandemic, we need to prepare now. The quickest, most cost-effective and efficient way to prepare for the next pandemic, and deliver millions of dollars in industry benefits in the meantime, is to set up an ETL network.

*Michelle Frazer is Director APAC at X-Lab Systems.

^{1. https://factly.in/no-scientific-basis-to-state-that-pandemics-repeat-every-100-years}

^{2. https://www.who.int/news-room/fact-sheets/detail/coronavirus-disease-(covid-19)}

^{3. https://www1.health.gov.au/internet/main/publishing.nsf/Content/99424DA2A5F3A488CA2589BA0019141B/$File/covid_19_australia_epidemiology_report_58_reporting_period_ending_13_february_2022.pdf}

^{4. https://www.fda.gov/regulatory-information/selected-amendments-fdc-act/21st-century-cures-act}

^{5. https://sparked.csiro.au/index.php/about-sparked/sparked-story}

^{6. https://www.health.gov.au/sites/default/files/2026-01/sparked-program-review-evaluation-report-2023-2025.pdf}

^{7. https://www.gov.uk/government/publications/nhs-test-and-trace-privacy-information/test-and-trace-overarching-privacy-notice}

^{8. https://www.politicshome.com/members/article/key-role-testing-preventing-covid-deaths}

^{9. https://vimeo.com/400686955}

^{10. Sprivulis P, Walker J, Johnston D, et al. The economic benefits of health information exchange interoperability for Australia. Aust Health Rev. 2007;31(4):531–539. doi:10.1071/ah070531}

^{11. https://www.news.com.au/world/nipah-virus-threat-very-serious-health-minister-warns/news-story/4cbe4be09913dba65e1e89b774c006fb}

Image credit: iStock.com/sanjeri