Article

The Interoperability upgrade

FHIR and HL7 V2's collective impact on Healthcare

Ashish Pauranik
Sr. Solution Architect, Interoperability Services, CitiusTech

Jun 23

Insights

Combining FHIR with HL7 V2 bridges gaps in data exchange, enhancing speed and accuracy in healthcare communication.
This integration approach leverages existing infrastructures while adopting new interoperability standards, avoiding costly system overhauls.
The integrated use of HL7 V2 and FHIR not only solves current interoperability issues but also strategically positions healthcare systems for ongoing advancements and improved patient outcomes.

Imagine standing in the quiet corridors of a pediatric clinic, where care is a race against time, and a critical piece of data is missing. Test results flow in electronically, yet they hang in limbo, unable to link to the EMR orders without the essential Provider Order Number. This number, crucial for integrating vital health information, is absent, creating a bottleneck that delays care.

Elsewhere, a mobile health unit operates with agility, moving to where it's needed most, extending care to the community's far reaches. They’re ready to dispatch HL7 V2 orders to a lab with the click of a button. But there’s a hitch—each order needs to carry the unique Lab Patient ID or MRN to be accepted, a requirement that adds a cumbersome step to an otherwise streamlined process. Without this piece of data, vital tests might be delayed, and critical moments lost.

Understanding the stakes:

The exchange of information is a critical lifeline for businesses and even more so for healthcare. It ensures the seamless delivery of care, supports decision-making, and enhances patient outcomes. Yet, the limitations of traditional data exchange methods, such as HL7 V2, are becoming increasingly apparent.

While HL7 V2 has served as the cornerstone of healthcare data exchange for decades, the evolution of digital health technologies calls for a more flexible, efficient, and scalable approach.^[1]

Why don’t healthcare stakeholders—providers, payers, diagnostics—adapt as quickly as other industries? A decade ago, this question sparked a huge transformation. And the industry responded by borrowing the tech stack and software developers’ expertise outside healthcare that is changing businesses worldwide.^[2]

The outcome is FHIR (Fast Healthcare Interoperability Resources), a data standardization format designed to enable better storage and exchange of data. FHIR leverages the power of web technologies and microservices to facilitate real-time data exchange and interoperability. In the United States, out of the almost $4 trillion poured into healthcare each year, around $1 trillion is earmarked for administrative costs.^[3] This sum represents a pool of potential savings that healthcare entities can tap into. On the surface, the advantage is obvious: providing healthcare professionals with the means for quicker and more precise patient care. But the deeper, more systemic implications for every participant in the healthcare system are significant and need comprehensive understanding.

Coexistence and integration of V2 and FHIR:

Should FHIR replace HL7 V2 outright? The answer is not straightforward. Despite FHIR's advanced capabilities, the wholesale replacement of HL7 V2 is neither practical nor economically sensible for most healthcare organizations.^[4] We need an innovative approach that combines the best of both worlds. With years of experience, FHIR capabilities and deep domain expertise, we figured that by integrating FHIR's capabilities into existing HL7 V2 frameworks, healthcare providers can enhance interoperability without the need for a complete system overhaul. Let’s take a closer look to understand the difference.

V2 interactions:

In the traditional model, we see family and specialty practices, along with mobile health units and emergency departments, exchanging data such as admissions, discharges, and transfer information (ADT) and orders (ORU/ORM) directly with hospitals, labs, and payers through HL7 V2 messaging. This setup has been the backbone of healthcare data communication, serving its purpose efficiently for years.

V2 + FHIR interactions:

With the industry and regulatory push to make healthcare data available in FHIR format, most of the EMR and hospital systems have introduced their versions of FHIR servers. The enhanced model uses these existing FHIR servers to enrich and seamlessly integrate V2 and other legacy data exchanges through FHIR enrichment microservices.

Here’s how it works: When a practice sends an HL7 V2 message, it may miss or do not have access to certain elements required for full comprehension or automated processing action by the receiving entity (hospital/lab/payer). In the traditional setup, the administrative staff is burdened with manual tasks. At this point, the FHIR enrichment microservices intercept the HL7 V2 message and utilize the FHIR servers to retrieve the missing information.

Once the data is enriched with the necessary details (like an MRN or specific lab order details), the FHIR-enriched HL7 V2 message is sent to the intended recipient, which is now complete and ready for automatic processing.

The impact is clear: We can now enable more detailed, complete, and accurate data exchange without manual intervention. It reduces the potential for error and delays that can impact patient care. Moreover, it exemplifies the strategic use of FHIR to enhance the proven HL7 V2 standards, thus protecting existing IT investments while adopting modern interoperability capabilities.

This incremental innovation not only addresses the immediate challenges of data exchange without a need to overhaul the complete infrastructure but also lays the foundation for future innovations in healthcare IT. It paves the way for more personalized and timely patient care. Finally, it aligns with regulatory trends pushing for greater data fluidity and access within the healthcare sector.

A forward-thinking model: Call for a collective shift:

The FHIR mandate is part of a broader push by healthcare regulators, particularly the Centers for Medicare & Medicaid Services (CMS), to promote interoperability and patient access to health information. The integration of HL7 V2 and FHIR offers a pragmatic and forward-looking solution for leaders. Visionary leaders should leverage the best of both worlds to enhance patient care and improve system efficiencies. Because the future of healthcare depends on our ability to adapt, integrate, and innovate.