Healthcare and clinical research are often described as data-rich environments. Yet, despite the volume of information available, the industry continues to feel fragmented.

Systems do not align. Processes do not connect. Insights remain difficult to scale.

The conversations at the Vulcan Futures Roundtable offered a clear explanation for why this fragmentation persists. It is not just a technology problem. It is a problem of alignment.

The Language Problem

At the centre of this issue is language.

Terms like interoperability, standards, and data integration are used constantly, but not consistently. Different stakeholders interpret them in different ways, shaped by their own roles, priorities, and experiences.

“Different people are talking about interoperability, but meaning different things.”

For a data scientist, interoperability might mean the ability to combine datasets from multiple sources for analysis ensuring semantic consistency so that comparisons are meaningful and repeatable. For a clinician, it might mean having access to a patient’s full history at the point of care. For a technology provider, it might mean system compatibility and data flow between platforms. Each perspective is valid. But without alignment, they do not converge.

Lilliam Rosario proposed a reframe: perhaps the industry should stop talking about “standards” altogether and instead talk about structure, harmonisation, and accessibility of knowledge. The vocabulary has become a source of confusion rather than clarity.

Standards That Silo

This divergence is compounded by the way standards have evolved.

Rather than being developed as part of a unified ecosystem, many standards have emerged to address specific use cases in isolation. Each one solves a problem but often without considering how it fits within the broader landscape. Over time, this has created a situation where multiple standards coexist, each adding a layer of complexity.

“Each standard considers the individual use cases, not the bigger picture.”

The result is a paradox. Standards are intended to simplify and unify. In practice, they can contribute to fragmentation when applied without coordination. The industry ends up with solutions that work in narrow contexts but do not connect across the ecosystem.

James McDermott drew an analogy to the benefits of a hub-and-spoke model: if you map system A to FHIR, and separately map system B to FHIR, you have automatically connected A and B and every future system you map creates multiple new connections simultaneously. The logic is elegant. The challenge is getting enough stakeholders to commit to the same hub.

The Human Dimension

What becomes clear is that solving fragmentation requires more than technical solutions. It requires a shift toward systems thinking, looking beyond individual components and considering how they interact within the broader ecosystem.

It also means addressing the human dimension of the problem. Fragmentation is reinforced by differences in incentives, priorities, and levels of understanding. Bridging these gaps requires more than integration, it requires communication, education, and collaboration.

One of the most striking observations from the roundtable was a frank acknowledgement that many stakeholders still do not fully understand the relevance of interoperability to their own work:

“I do not think people are getting it.”

This points to a fundamental challenge. A physician in a community hospital is focused on patient outcomes not on FHIR implementation guides. An administrator managing a small IT team may not have the resources to engage with standards work. Even within organisations that understand the value of interoperability in principle, the connection between technical capability and day-to-day impact often remains unclear.

The solution is not to simplify the problem, but to translate it, to connect technical capability to real-world outcomes in a way that resonates across the ecosystem. That means demonstrating success through concrete examples, building the case one use case at a time.

The Role of Collaboration

This is where Vulcan plays a unique role.

By bringing together diverse stakeholders in a shared environment sponsors, technology providers, implementers, healthcare organisations, Vulcan helps create alignment. Not by imposing a single perspective, but by facilitating understanding between different ones.

It also creates the conditions for visibility. When successes are shared, when others can see what has been achieved and build on it, the case for engagement becomes more tangible.

Fragmentation is not just about disconnected systems. It is about disconnected thinking. And solving it requires bringing those perspectives together.