By Dr Andy Bond, Interoperability Architect, Magentus
A patient leaves their specialist with a pathology request addressed to one laboratory, then takes it to another provider’s collection centre down the road.
Patients have always been free to make that choice. Australian Government policy requires every branded request form, paper or electronic, to make that clear. Until recently, however, a digital pathology request could not follow the patient to another provider. Choosing a different laboratory often meant returning to paper and re-entering information by hand.
At SNOMED CT Expo 2026 in Sydney this week, I shared how we have helped change that. Working with Australia’s three largest private pathology providers, Sonic Healthcare, Australian Clinical Labs and Healius, we have helped make digital pathology requests portable at production scale, an Australian first.
The significance extends beyond pathology. It demonstrates how healthcare interoperability standards such as FHIR®, SNOMED CT® and digital pathology eRequesting can move from pilot projects into routine clinical practice at national scale.
For years, healthcare interoperability initiatives focused on proving that standards could work. The challenge now is making them work across competing organisations, at high volume, and within the realities of everyday clinical workflows.
Our premise was simple: wherever a digital pathology request goes, its clinical meaning should remain unchanged.
How healthcare interoperability preserves the meaning of a digital pathology request
For that to happen, a pathology request must retain both its structure and its clinical meaning as it moves between independent organisations and systems.
In healthcare, interoperability is often described as the ability to exchange information between systems. In practice, true healthcare interoperability means preserving the clinical meaning of that information as it moves between organisations and ensuring consistent understanding of the clinical workflow supporting the interactions.
Three sets of standards work together to make this possible.
The HL7® AU eRequesting standard, developed openly through HL7 Australia and the Sparked FHIR® Accelerator, enables electronic pathology requesting (eRequesting) to move between systems. The RCPA’s Standards for Pathology Informatics in Australia (SPIA) define what a digital pathology request contains and curates the requesting reference set, including the Top 50 most-requested tests. SNOMED CT®-AU provides the governed clinical terminology that gives each coded pathology request a consistent and computable meaning.
The specification also separates the clinical request from the task of fulfilling it. The clinician authors the request once, and it remains unchanged. The laboratory the patient chooses claims the fulfilment task, while the requester can track its progress.
Digital requests now part of everyday practice
Since June 2024, clinicians using Genie and Gentu practice management software have sent 1.9 million digital pathology requests to the three providers. In September 2026 alone, 180,881 pathology requests contained 860,728 individual test requests, with volume reaching 3.4 times the September 2025 level.
These volumes show that digital pathology interoperability is now part of routine clinical practice, not simply a pilot or controlled demonstration.
For clinicians, portable digital pathology requests reduce the risk of information being lost, reinterpreted or re-entered between organisations. For laboratories, they reduce manual handling and support more consistent processing. For patients, they preserve provider choice without requiring a return to paper-based workflows.
Use of the claiming model is also growing, from 493 orders in November 2025 to 11,061 in September 2026. Of the September total, 26 per cent were claimed by a provider other than the one originally addressed. Another 67 per cent were open or paper requests brought onto the digital pathway. These figures demonstrate how digital pathology interoperability can support both provider choice and the transition from paper to digital workflows.
Why digital exchange should come before terminology standardisation
One lesson others can apply is that digital exchange does not need to wait until every test uses a standard code.
Providers went live with digital pathology exchange first, then progressively introduced SNOMED CT®-AU concepts alongside local codes and free text, preserving information throughout the transition. Monthly coded test requests have grown 23-fold, from 14,770 at go-live to 349,065 in September 2026. Of those September coded requests, 88 per cent use a SPIA concept.
That growth is substantial, but more than half of all test requests last quarter still travelled as free text alone. The next challenge is extending standardised coding across that volume. Achieving that depends as much on governance of individual providers’ test catalogues as it does on expanding the shared terminology reference set.
The Top 50 tests illustrate the challenge. All three providers offer them, but only 23 are coded identically across all three organisations.
What successful healthcare interoperability adoption depends on
Beyond the standards themselves, three lessons stand out.
First, patient choice must guide the design. Making a digital pathology request portable must still respect the patient’s decisions about where the request, and their information, can go.
Second, adoption is easier when new workflows feel familiar to clinicians and laboratory staff. Staged implementation allows organisations to build on existing ways of working rather than replace them outright.
Third, healthcare interoperability requires collaboration as much as technology. Neutral forums, shared governance and open standards help competing organisations agree on how information should be exchanged. Technology alone is not enough.
What comes next
The next step is closing the loop by linking pathology results to the original digital request. This would give the requester, laboratory, other treating clinicians and patient a shared record of what was requested and what was found; an end-to-end digital experience.
The approach has relevance well beyond Australia and pathology. The same combination of FHIR-based interoperability, governed clinical terminology and digital requesting workflows could support connected care across referrals, diagnostic imaging, oncology and many other clinical domains.
The broader lesson is clear. Use FHIR to share and track requests. Use common and governed terminology to preserve meaning. Use real-world implementation to prove how those standards work together at scale.
For me, the purpose remains straightforward. Patients choose where their pathology collection takes place, determining their chosen service provider. Our job is to make sure the request retains its clinical meaning wherever they go.
Interoperability is not simply about moving data between systems. It is about preserving meaning across healthcare.
Ultimately, that is what healthcare interoperability should deliver in everyday care.
HL7® and FHIR® are registered trademarks of Health Level Seven International, and their use does not constitute endorsement by HL7. SNOMED and SNOMED CT® are registered trademarks of the International Health Terminology Standards Development Organisation (IHTSDO), trading as SNOMED International.
