The lack of a common health data language has been ‘the elephant in the room’ for a very long time. Unfortunately, very few people acknowledge the need for a clinical lingua franca as a critical foundation for eHealth. The mainstream view seems to be that messages are/will be enough and that creating a standard language for health information is either too hard or too complicated. Is it really that hard? Or is that just the view of those with vested interest in perpetuating the message paradigm?