Bridging the Gap: Why the Healthcare Industry Should Embrace FHIR Over HL7v2

In today's healthcare environment, integrating applications directly into Electronic Medical Records (EMRs) can be a necessary competitive advantage. As healthcare providers strive to improve patient outcomes through data-driven decisions, the demand for efficient and reliable data exchange has never been higher. However, the journey toward interoperability is fraught with challenges, particularly when dealing with legacy systems and outdated standards like HL7v2. We look forward to the move towards FHIR for more use cases.

The Complexity of Integrating Applications with EMRs

Integrating third-party applications with EMRs is a complex endeavor. It involves not only technical considerations but also navigates regulatory compliance, data security, and the need for real-time data access. The ultimate goal is to create a streamlined flow of information that enhances patient care without adding burdensome processes for healthcare providers.

HL7v2: The Traditional Workhorse

For decades, HL7v2 has been the backbone of healthcare data exchange. Introduced in the 1980s, it was designed to facilitate the exchange of clinical data between disparate healthcare systems. While HL7v2 has been instrumental in advancing interoperability, it comes with significant limitations:

Complexity and Ambiguity: HL7v2 messages are complex and often lack consistency between implementations, leading to interoperability issues.
Outdated Technology: It relies on older technologies that are not compatible with modern web standards, making integration cumbersome.
Customization Overload: The standard allows for extensive customization, which means that no two implementations are exactly alike, complicating the integration process.

FHIR: The Modern Solution

FHIR, developed by HL7 International, represents the next generation of healthcare interoperability standards. It leverages modern web technologies, making it more adaptable and easier to implement. Here are some of its key advantages:

Ease of Implementation: FHIR uses RESTful APIs and common data formats like JSON and XML, which are familiar to most developers.
Extensibility: FHIR is designed to be extended and adapted without losing compatibility, allowing for innovation while maintaining interoperability.
Stronger Implementation Guidance: FHIR implementation Guides and modern tooling provide more structure on how to implement FHIR.

Topology Health's Experience: A Case Study

Recently, Topology Health partnered with a client to integrate a new application with their existing EMR system, which operates on HL7v2 standards. What should have been a straightforward process turned into a series of challenges:

Technical Minutiae: The team spent countless hours troubleshooting message formats and field mappings due to the ambiguities in HL7v2.
VPN Setup and Connectivity Problems: Establishing a secure connection required multiple meetings and coordination between technical departments on both sides, delaying the project timeline.
Miscommunication: The lack of standardized documentation led to misunderstandings about data requirements and expectations.
Lack of Process or Documentation: Each issue had to be addressed ad-hoc, as there was no comprehensive guide to navigate the integration process.

Had the EMR vendor exposed the required data over FHIR, we could have circumvented many of these issues. The standardized nature of FHIR, along with its use of modern web protocols, would have streamlined the integration process, reduced the need for complex VPN setups, and minimized miscommunication.

The Case for Moving to FHIR

The challenges we've faced aren't unique to Topology Health; they are symptomatic of a broader industry issue. By adopting FHIR, healthcare organizations can:

Enhance Efficiency: Setting up a client ID in the EHR Auth Gateway using FHIR takes approximately 4-8 hours, whereas establishing a new HL7v2 endpoint often requires a week or longer. This significant reduction in setup time lowers development costs and accelerates the integration of new applications.
Improve Interoperability: Facilitate seamless data exchange between systems, improving patient care coordination.
Stay Current with Technology: Leverage modern web standards like TLS and OAuth2.0, which are more secure and scalable.
Foster Innovation: Enable developers to create new applications and services that can plug into EMRs with minimal friction, thanks to standardized APIs and protocols.

Conclusion

While HL7v2 has been a key part of healthcare data exchange for decades, its limitations pose challenges to innovation and efficiency. At Topology Health, we recognize the enduring role of HL7v2 in many existing workflows and understand that numerous current use cases still rely heavily on this standard. Therefore, supporting HL7v2 remains a core part of our interoperability strategy, ensuring continued integration with established systems.

At the same time, our experience has reinforced the need for a modern, standardized approach to data exchange. FHIR offers a viable path forward, addressing some of the shortcomings of HL7v2 and paving the way for a more interconnected healthcare ecosystem. However, we acknowledge that not all use cases can be addressed solely with FHIR today. By continuing to support HL7v2 while embracing FHIR, we aim to facilitate a smooth transition toward advanced interoperability, catering to both present needs and future improvements.

We look forward to broader FHIR adoption, which is on the horizon with upcoming regulations like the ONC's HTI-1 rule, effective January 1, 2026, and the proposed HTI-2 rule slated for January 1, 2028. Embracing these changes will not only alleviate the technical burdens we've discussed but also unlock new opportunities for improving patient care through enhanced data accessibility and interoperability.