FHIR vs. HL7 Version 2: What to know about interoperability

What exactly is HL7? For more than 30 years, Health Level 7 has been a widespread standard for data exchange, enabling hospital information systems to communicate clinical and administrative data to each other.

In the early 2010s, amid the growing use of smartphones and the ubiquitous Internet, Fast Healthcare Interoperability Resources, or FHIR, emerged as a promising new standard for interoperability in the industry.

“The real game changer of FHIR versus HL7 V2 is the universal applicability,” says Daniel Golder, principal at health consulting firm Impact Advisors. “FHIR opens the door to mobile devices, apps and wearables. It allows the user, the app, to exploit the information. “

Here’s more about these two key standards, how interoperability in healthcare has changed over the years, and how the future looks in the context of federal guidance.

Healthcare Data Management is evolving from HL7 V2

Hospitals had an increasing need to connect more systems. First released in the late 1980s, the HL7 V2 has become one of the most widely implemented standards for health data worldwide, according to HL7 International. About 95 percent of U.S. healthcare organizations use the HL7 V2, and it is used in more than 35 countries.

Over time, the existence of data outside hospitals became harder to ignore. Payers, pharmacies and laboratories all had data so that expectations and the importance of interoperability had to be adjusted. An increasing amount of data was also created, recorded and stored in healthcare systems.

READ MORE: Learn 3 important steps to comply with the CMS Data Accessibility Regulation.

“The HL7 V2 still has its purposes; it really needs to be predefined. It requires much more effort in many ways to implement that information, ”says Golder.

A major benefit of the HL7 V2 was its widespread use, says Aaron Seib, senior vice president of strategy and innovation at IT and data management firm NewWave. Its longevity is certainly remarkable, and Seib expects the standard to still be used in certain scenarios.

“There was this different, mysterious art that was unique to healthcare,” Seib says. “What we benefit from in the FHIR world is that we have adopted the technology stack used for other applications in other industries.”

What is FHIR and what does it mean for healthcare?

After the rise in app use and smartphone ownership in the early 2010s, IT executives in the healthcare sector such as Grahame Grieve, the architect behind FHIR and the FHIR product director at HL7, sought to rethink the exchange of healthcare information in a more contemporary context.

The decades-old HL7 V2 had been created before widespread internet use. Version 3, which tried to solve certain problems in its predecessor, had not been widely implemented due to its complexity.

FHIR drew on previous HL7 standards and combined them with current web service technologies, such as those operating e-commerce services.

Think of it as a travel site that Dr. Russell Leftwich, senior clinical consultant for interoperability at the software company InterSystems and adjunct assistant professor of biomedical informatics at Vanderbilt University, described in an online presentation.

LEARN MORE: Find out how interoperability increases the efficiency and transparency of healthcare.

When people visit travel sites, they can see a list of flights from different airlines for a particular trip on a particular date. These sites not only download all schedules; the airlines have agreed on how to represent the data for a flight, how to request them and what data a user gets back in return.

“FHIR is the same for healthcare,” Leftwich said in his presentation. “It’s the same technology, and it’s the agreement on the importance of data in healthcare. And of course, that’s where it’s getting a lot more complicated, because healthcare is more complex than air travel. ”

The expansion of FHIR also signaled a broader pool of talent to recruit from, Seib says, such as RESTful API developers with no hospital-specific background.

“We have a new technology stack that is not as unique as the healthcare system once was with V2 messages,” adds Seib. “The technologies we use are really suitable – it’s faster as an architect and engineer to use the technology stack we use.”

An interoperable future in healthcare

Interoperability in the healthcare sector has made significant progress since the Health Information Technology for Economic and Clinical Health Technology Act (HITECH) was adopted in 2009. Seven years later, with the 21st Century Cures Act, provisions aimed at healthcare IT helped make ONC a driving force for greater interoperability, following the release of the final rule in 2020.

As the COVID-19 pandemic revealed the gaps in healthcare information sharing, interoperability has been a critical area of ​​investment for providers.

Golder recommends that health organizations keep an eye on the timelines of the Trusted Exchange Framework and the Common Agreement, which he describes as an attempt to “establish a single ‘on-ramp'” for the exchange of health information. He adds that there are not enough stakeholders paying attention to the October deadline to make all electronic health information available.

“Get to know the law, learn your time frame to make this known, and do not procrastinate,” Golder says.

Organizations should also consider privacy and security risks as interoperability improves in healthcare, especially as patients navigate multiple apps and digital contact points.

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