Health care is currently fragmented, as are its IT systems, and each excludes partner care services which are important in supporting citizen health. Citizens see commercial international interoperability such as in banking, and wonder why the health sector cannot match that even at local level. The focus on inter-operability priorities is on health system interoperability, in the context of a policy of full European interoperability by 2015. However, the priority for citizens is to see coordination of objectives and delivery of care and assurance of day-to-day delivery of integrated care involving not just health but other agencies. A change from international vertical healthcare inter-operability, to horizontal citizen-based inter-operability should be considered the priority.