Digitising trust: building the backbone of Pakistan’s future health system—I

From paper to platform: the interoperability imperative for Pakistan’s health system.

In Pakistan, a nation with a population of approximately 250 million, the promise of digital health seems tantalizingly within reach. Multiple systems and databases are being built; hospitals are generating electronic logs, and health apps are proliferating. However, despite this surge in data collection, the core issue remains: interoperability. Without the ability to exchange, link, and meaningfully use health data across platforms and providers, these systems become little more than expensive add-ons.

Recent research shows that while Pakistan has nascent digital health initiatives, major barriers persist: “limited capacity… for being able to use data to advance health”, and “multiple barriers … including platforms for sharing data, interoperability and defined win-win scenarios.”

However, many facilities still rely predominantly on paper-based systems. A study found that the health information system “partially existed at district and sub-district offices, while was completely absent at tertiary, secondary and primary healthcare levels.”

This means that hospitals may have databases, but if those databases cannot communicate with each other and cannot trace a patient’s journey across clinics, laboratories, insurers, and hospitals, then the investment yields little insight and coordination and leaves patients vulnerable.

Meanwhile, the cost of creating these standalone systems adds to the overall healthcare expenditure without delivering the expected returns in terms of efficiency, safety, or equity.

Digitizing records is no longer optional; it is a dire need of the hour. However, digitization alone is not sufficient. To realize the full value of data, Pakistan must build interoperable systems: databases that are connected, standards that are shared, and workflows that cross institutional boundaries. Only then can health data become actionable, enabling continuity of care, informed policy-making, and real-time public health responses, rather than remaining locked-in islands of information.

In the sections that follow, we unpack the key discrepancies that arise when manual (or siloed digital) health systems dominate in Pakistan, from patient experience to national health planning, and why bridging these gaps is vital for a just, efficient, and high-performing health system.

The weight of paper: how manual records cripple Pakistan’s healthcare system

Walk into any government hospital or small private clinic in Pakistan, and you will find the same scene repeated: rows of steel cabinets filled with crumbling patient files, overworked clerks leafing through paper registers, and doctors scribbling hurried notes on prescription pads.

Despite scattered attempts at digitization, the bulk of healthcare documentation in Pakistan remains paper-based, a reality that has quietly shaped every inefficiency faced by patients and providers.

A patient with diabetes in Multan, for instance, may visit three different clinics in six months, none of which has access to her previous lab results. Each visit starts with a blank file, repeated tests, and another consultation fee. This cycle is repeated endlessly.

Paper records have inherent limitations that compound over time. They are static, fragile, and non-shareable. A patient treated at one facility leaves with a file that has no digital counterpart, meaning that when they visit another clinic, their story starts all over again. The test results are redone, history is retaken, and medication lists are rewritten. This repetitive cycle not only wastes precious clinical time but also increases costs for both patients and the health system.

The consequences for clinicians are equally draining. Without an integrated record system, information retrieval is a manual, error-prone process, misplaced lab results, undocumented treatment plans, and unrecorded allergies. In high-volume facilities, missing files can delay surgeries or even misdirect treatments. A single data gap in a paper can lead to life-threatening outcomes.

On an institutional level, manual records mean no visibility, analytics, or learning loops. Hospitals cannot easily monitor disease patterns, manage their inventory, or track their performance. Health administrators rely on end-of-month summaries compiled manually, which are often riddled with inaccuracies. The absence of real-time data makes it nearly impossible to forecast outbreaks, allocate resources effectively and plan preventive interventions.

The irony runs deep: while Pakistan’s financial and telecom sectors have embraced real-time digital ecosystems, its health sector is still anchored in pen-and-paper systems that belong to a bygone era. For facilities that have adopted basic digital tools, these often exist as isolated silos, unable to exchange information or follow a patient beyond their own premises.

This brings us to the core of the national challenge: in a fragmented landscape where health systems do not communicate with each other and paper still dominates, the absence of clear government policy and interoperability standards has left the sector without a unifying direction.

The policy vacuum: when innovation outpaces governance

While Pakistan’s healthcare providers are still grappling with paper-based systems, another challenge is the absence of a clear, unified digital health policy. Without strategic direction or regulatory enforcement, digitization efforts across the country are disjointed, reactive, and often redundant.

The federal and provincial health departments have long acknowledged the need for digital transformation; however, progress remains fragmented. There is no national mandate on electronic health record (EHR) standards, no established framework for interoperability, and no governing authority enforcing compliance with data exchange protocols such as HL7 or FHIR. The result is a patchwork of disconnected systems, rather than a cohesive digital ecosystem.

This policy void also affects how data flows — or rather, fails to flow — between stakeholders. Hospitals, laboratories, pharmacies, and insurers all operate on independent databases with no national Health Information Exchange (HIE) to connect them. Even provincial health data repositories, where they exist, function as static archives rather than dynamic, real-time systems that can generate actionable insights.

Furthermore, there are no enforceable data security or privacy regulations tailored to healthcare, leaving sensitive patient data exposed to breaches, misuse, or commercial exploitation. The lack of a central data governance authority not only hinders accountability but also discourages institutions from sharing data, a cultural and operational barrier that perpetuates isolation.

In such an environment, innovation often outpaces regulations. Startups, private hospitals, and tech vendors are developing digital health platforms to fill these gaps, which is an encouraging trend. However, without interoperability guidelines or policy oversight, these solutions are growing in silos, each using its own data schema, storage conventions and exchange formats.

Today, fewer than five percent of Pakistan’s healthcare facilities use any form of structured electronic record keeping. Among those that do, most systems do not conform to HL7/FHIR standards, making cross-platform communication nearly impossible. The irony is striking: as HealthTech companies rise, many build proprietary EHRs designed entirely around in-house data models, inadvertently creating the next generation of data silos.

If this continues unchecked, the health sector could soon find itself facing a new kind of fragmentation — one where digital systems exist, but each speaks a private language, making national interoperability even harder to achieve.

Emerging islands of innovation: the digital shift without a common language

Despite the absence of a unified national policy, Pakistan’s health sector has made progress. Over the past few years, a wave of HealthTech startups and digital platforms has begun to reshape healthcare access and management. From teleconsultation apps and e-pharmacy networks to hospital management systems and insurance technology solutions, this quiet digital revolution signals that the sector is ready to evolve.

However, when seen in totality, these efforts represent less than five percent of the digital transformation Pakistan needs to bring its healthcare infrastructure into the 21st century. Most of these platforms operate within narrow domains — limited to outpatient consultations, pharmacy logistics, or hospital operations — rather than being part of a broader, interoperable ecosystem.

The core challenge lies in the lack of common technical standards. Health data across these digital systems exist in multiple formats, often determined by the internal logic of the software vendor. Without alignment on HL7 (Health Level Seven) or Fast Healthcare Interoperability Resources (FHIR) standards, the global frameworks that define how health information should be structured and exchanged, these systems cannot “speak” to each other.

This lack of standardization has serious implications. Imagine a patient who consults via one telemedicine app, gets lab results from another, and fills prescriptions through a third, each storing data in its own proprietary database. None of these systems can synchronize or cross-reference information with each other. The result is digital fragmentation, a mirror image of the manual chaos Pakistan was meant to escape.

The growing number of companies branding themselves as HealthTech further complicates this picture. Many offer EHR or hospital management solutions developed around closed, in-house data models. While such tools may appear functional for individual facilities, they pose long-term interoperability risk. Once hundreds of clinics and hospitals begin using EHRs designed in unique, incompatible formats, national-level data unification becomes exponentially harder; every dataset becomes a locked vault, each with its own key.

However, vision alone cannot connect systems; it must be engineered through a structured national roadmap.

(To be continued)

Copyright Business Recorder, 2026