Data Without Borders: Luciano Brustia on Health Interoperability, Government Data Sharing, and the Real Challenges of Digital Transformation in Southeast Asia

Q1. You have been working across Asia for nearly 20 years, helping healthcare systems in more than 30 countries connect fragmented data into something coherent and usable. Indonesia’s healthcare transformation has been described as “more than a national achievement — a catalyst for other countries in the region.” But Satusehat, despite a strong start, has not yet seen the widespread adoption that was hoped for. From your direct experience on the ground, what are the real barriers to adoption — not the ones that appear in policy documents, but the ones you encounter in conversations with hospital administrators, ministry officials, and clinicians — and what does it actually take to move a national health data program from a technically sound initiative to one that people actually use?

The biggest misconception is that interoperability is primarily a technology challenge. In reality, technology is often the easiest part.

When I speak with hospital administrators, officials, and clinicians, the barriers are usually human, organizational, and operational. Clinicians are focused on patient care and often view data submission as a waste of time. Hospital administrators are

concerned about costs and resources. Government agencies see the problems but often underestimate the change management required to collect meaningful data.

I’m glad you mentioned SATUSEHAT in Indonesia, which represents a remarkable achievement. Believe me, creating a national platform capable of connecting thousands of healthcare providers across a geographically complex country is not a trivial accomplishment.

However, building the platform is only the first phase. The harder phase is driving usage, which accelerates only when participants clearly understand the value they receive in return for sharing data. If hospitals perceive interoperability only as a reporting obligation, participation will be limited. If they see better care coordination, reduced administrative burden, improved reimbursement processes, enhanced clinical decision-making, or access to broader patient histories, usage and value increase, and the platform becomes much more sustainable.

The countries that succeed treat interoperability as a long-term national transformation program rather than a technology deployment. It requires leadership, incentives, education, trust, and continuous engagement with the people who use the system every day.

Q2. Thailand and the Philippines are making progress on health data interoperability, while other countries in the region are at very different stages.  You have said that Asia is “uniquely positioned to leapfrog traditional models of care.” But leapfrogging requires not just technology but political will, institutional trust, and governance capacity. In your observation across Southeast Asia, what distinguishes the countries that are genuinely making progress from those that are stuck — and what is the single most important condition that needs to be in place at the government level before a national interoperability program has any realistic chance of working?

Let’s be clear: I personally believe that all countries are genuinely trying to address health data interoperability and make progress. Some treat interoperability as a national strategic priority rather than an IT initiative, and they are the ones who see progress earlier than others.

Technology is necessary, but it is never su;icient. Clear governance structures, sustainable funding mechanisms, and standards are the keys to having earlier success.

One observation is that progress tends to accelerate when healthcare interoperability aligns with broader national priorities, such as universal healthcare coverage, public health resilience, healthcare cost management, or economic modernization.

When governments provide consistent direction, establish standards, and maintain a long-term commitment, healthcare organizations gain confidence to invest.

Interoperability is ultimately a collective e;ort. Every participant must believe that others will also contribute and comply.

Q3. You have said that “AI success depends not only on models, but on trusted, interoperable data ecosystems and strong industry collaboration.” That is a sentence most people in the AI industry should read twice. In Southeast Asia specifically, where fragmented legacy systems, inconsistent digital literacy, and data sovereignty concerns all coexist, what does it actually look like in practice to build a trusted, interoperable data ecosystem — and what have you learned about what governments and health systems need to stop doing, not just start doing, to make that possible?

I recently heard the following comment: “There is no AI strategy, without a data strategy. There is no data strategy without an interoperability strategy”. Today, everyone talks about AI, but many organizations are still overlooking a fundamental reality: AI can only be as good as the data that supports it. AI is a beautiful rooftop, but you need solid foundations to be sure the house stands.

In life, “trust” is everything. A trusted data ecosystem is one where data is accurate, governed, standardized, secure, and accessible to authorized users when needed. That sounds straightforward, but achieving it requires years of investment and collaboration.

In practice, this means establishing common standards, clear data ownership policies, robust consent frameworks, strong cybersecurity protections, and governance mechanisms that ensure accountability.

Equally important is what organizations need to stop doing. They need to stop treating data as an isolated organizational asset confined inside their own company boundaries. They need to stop launching disconnected pilot projects that create new silos. They need to stop focusing exclusively on short-term technology procurement while neglecting long-term governance and workforce development.

Many healthcare organizations continue to invest heavily in AI while their underlying data remains fragmented, inconsistent, or siloed.The organizations seeing the greatest success are those that first build strong digital foundations and then deploy AI on top of trusted, interoperable data environments.

Q4. Provincial and national data sharing programs in healthcare face a structural tension that technology alone cannot resolve: the data that is most valuable when shared is often the data that institutions are most reluctant to share, for reasons of competition, liability, privacy, and political accountability. You have navigated this tension across multiple countries and health systems. What governance models, incentive structures, or institutional arrangements have you seen actually work in Southeast Asia — and what can other regions, including Europe and Latin America, learn from what is being tried in ASEAN right now?

We need to take a step back: several countries, especially in Asia, are on the brink of significant changes, with a large number of young people who might develop chronic diseases within a decade. These countries cannot afford to wait and must act quickly to establish systems that use a common language (FHIR), share data, prevent duplicate exams, and maintain consistent medical histories for citizens.

Incentives are also crucial: organizations are more inclined to share data when they see clear, measurable benefits, such as better funding mechanisms, streamlined regulatory reporting, improved patient outcomes, or access to valuable analytics and benchmarking tools.

Q5. You began your career as CIO for groups of hospitals in Italy before spending nearly 30 years at InterSystems building health data infrastructure across Asia Pacific. That combination of having been a customer and then spending decades on the vendor and advisory side gives you a perspective that is genuinely rare. What is the most important thing you learned from being a CIO that you carry into every conversation with a government or health system today — something that shapes how you think about what they actually need versus what they say they need or what technology vendors are inclined to offer them?

When a customer calls, there is a problem. We need to treat all customer calls with empathy, trying to understand the underlying pain. Also, my years as a CIO taught me a lesson that has remained true throughout my career: healthcare organizations do not buy technology: they invest in outcomes. When I sit down with a minister, hospital CEO, or health system leader, I try to understand the problem they are trying to solve before discussing any technology.

As CIO, I quickly learned that clinicians rarely ask for a new platform (doctors really dislike changes). They ask for more time with patients. Technology is only valuable if it helps achieve those objectives.

Qx. Anything else you wish to add?

Roberto, I want to thank you because this interview brings back old memories of when I started my career. This makes me think I have been very lucky to witness, for 30 years, the healthcare digital transformation around the world.

And if there is one message I would leave is that we should never forget that the ultimate objective is better healthcare.

Interoperability matters because it enables clinicians to make more informed decisions, helps patients navigate healthcare systems more effectively, supports public health planning, and creates the foundation for responsible AI innovation.

Asia has a unique opportunity. Many countries are building digital health infrastructure at a time when cloud computing, interoperability standards, and AI technologies have matured significantly.

The countries that will lead in the next decade will not necessarily be those with the most advanced technology. They will be those who successfully combine technology, governance, trust, and human-centered design into a coherent national strategy.

At the end of the day, healthcare transformation is not about systems connecting to systems. It is about people connecting to better outcomes.

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Luciano Brustia, Managing Director, APAC, InterSystems

Luciano Brustia leads Asia Pacific business operations for InterSystems. Since joining in 2003, Mr. Brustia has held a number of leadership roles in the company and been instrumental in building long-term relationships with customers and implementation partners in more than 15 countries on four continents.

Prior to joining InterSystems, Mr. Brustia worked as an implementation partner for InterSystems and as CIO for several groups of hospitals in Italy. Mr. Brustia studied Electrical Engineering at Polytechnic University of Milan and received his Master’s degree in Information Technology Management in SDA Bocconi School of Management, 1995.

Sponsored by InterSystems.