It is no secret that healthcare software systems have become the cornerstone of the healthcare industry. Whether that be a normal practice, a large hospital, or even a pharmacy, you need an EHR software system of some sort or other.
This digital transition in the healthcare industry has clearly improved operations and administration, bringing transparency along with some other factors. One of the major factors has been improved communication between separate entities.
Gradually, software systems started to enter the mainstream, and both healthcare practices and healthcare IT companies realized that they needed a standard practice to streamline communications. While there were many standard patterns, the different approaches entities chose made it difficult for the systems to understand data.
Amidst this, HL7, or Health Level 7, rose to be a standard development organization that provided a framework for exchanging electronic health information. But, as technologies started to evolve with healthcare, many standards arose, and many healthcare IT companies started providing HL7 integration services for EHR or healthcare systems.
Now, as of 2025, many healthcare institutes, realizing the shortcomings of generic software, choose to adopt a custom software development approach. And for their disparate system to communicate with other systems, they need to adopt the right standard so that they can communicate efficiently and effectively.
And from the wide range of standards to select, the probability of choosing HL7 v2.x proves to be adamant, given its high adoption rate. However, another standard that is slowly becoming a standard standard for healthcare organizations is known as FHIR.
So, if you are someone looking to find the right standard for your custom EHR software, which one would you choose?
Well, in this blog, let’s have a look at both the standards and try to build a framework that will help you make the right decision. So, without further ado, let’s get started.
Understanding the Fundamental Differences
Let’s start with understanding the fundamental differences between the standards and what can be the benefits one can get from them.
Message-Based Vs. API-first Architecture
On the surface, HL7 integration services are built on structured messaging protocols for systems to establish communication with each other and exchange data. On the other hand, FHIR chooses an API-first approach, where they leverage modern RESTful web services for real-time data access.
Now, depending on the standard you choose, the complexity, requirements, and system flexibility changes. That is, making the right decision here is important.
Data Structure & Exchange Paradigms
Another fundamental difference between HL7 integration and FHIR API integration is in its data structure and exchange paradigms. You see, HL7 uses a pipe-delimited message format, whereas FHIR uses a resource-based JSON/XML format. This difference makes the one best for batch processing, which is a fairly reliable delivery method; on the other hand, the other FHIR API integration is best for granular and real-time data access.
This difference in their data structure and exchange paradigms can affect the semantic richness and can lead to standardization differences, which can clearly impact the interoperability of your software systems.
Implementation Complexity & Technical Requirements
If you choose HL7 integration services, then you require a specialized interface engine and proper messaging infrastructure to exchange information. If you choose the latter, it allows you to directly communicate with the application with standard web protocols.
So, implementation complexity is equal on both ends, but the technical requirements are completely different. That is why, whichever you choose, check developer skill requirements and the learning curve for each standard.
Note: HL7 has been a standard for healthcare for nearly more than a decade. Whereas FHIR API integration has one of the highest adoption rates and uses modern tools and cloud-native support.
Technical Implementation Considerations & Resource Requirements
The technical aspects of both standards are unique; despite both being developed by HL7, they flourish in completely different ecosystems. So, to make the choice about their technicalities easier for you, here are some things that you must consider:
Infrastructure & Platform Requirements
As discussed earlier, HL7 integration services need you to have a decided interface engine to process the request and respond, along with a messaging middleware. However, FHIR API integration requires you to leverage the existing web infrastructure and cloud platform to send requests and receive responses.
Given the highly volatile nature of healthcare and the technological landscape, scalability characteristics must be taken into account before making a decision. Also, while you’re at it, also consider high-volume environments.
Development & Maintenance Resource Implications
HL7 integration services will implement the standards for exchanging. Given its uniqueness of middleware and interface engine, it requires specialized expertise and proprietary tools. Similarly, FHIR requires standard web development skills and leverages DevOps practices so that it can successfully be integrated into your system.
However, the ever-changing nature of technology and regulators can give rise to complexities that need to be considered.
Security & Compliance Implementation Approaches
The security model of HL7 integration services is based on VPN, point-to-point encryption, and network-level controls so that your data can stay safe both at rest and during the transition. On the other hand, FHIR API integration depends on FHIR OAUth 2.0 and modern authentication standards. This gives you fine-grained access control.
Despite this, audit logging and compliance tracking for each standard are necessary because security threats are always a looming threat for the healthcare industry.
Note: To give you a nudge in the existing healthcare IT infrastructure, HL7 is compatible with legacy systems and established healthcare vendor ecosystems. Whereas FHIR API integration is more suitable for modern cloud platforms, mobile applications, and third-party services.
Use Cases Analysis: When to Choose HL7 Vs. FHIR
If you’ve come here, then you must have a brief idea about the technical aspects of both HL7 and FHIR. However, it’s still not clear which one you should choose. So, let’s try to help you make that decision.
Where is HL7 Best Suited
Now, the healthcare industry is one of the highly complicated and also widespread to classify into defined categories. But still, we can make an effort, right? So, if you are a large-scale facility with a high volume of transaction processing between multiple healthcare systems, then HL7 becomes your ideal choice.
However, its mission-critical interfaces require you to guarantee message delivery and extensive error handling. So, if you are a healthcare practice with existing HL7 infrastructure, then with a little assistance, HL7 standards can be easily integrated into your systems.
FHIR Ideal Implementation Scenarios
If you are a healthcare practice with a high level of patient engagement, which requires real-time data access and mobile accessibility, adopting FHIR API integration can be your ideal choice. However, innovative initiatives with third-party developers and modern application ecosystems are required.
On the other hand, a special emphasis must be placed on regulatory compliance for patient data access and information blocking rules.
Hybrid Approach Considerations
If you are a mix of both the scenarios mentioned above the n the question, ‘Why can’t I use both?’ must be lingering, right? Well, you can use both HL7 integration and FHIR API integration.
However, you need to strategically plan the use of both standards for different integration scenarios. Also, migration strategies from HL7 to FHIR for specific use cases should also be considered.
Cost Analysis & Return on Investment Considerations
Coming to the most important part of HL7 integration services and FHIR API integration are the cost and ROI. Let’s try to decode this one on a larger scale so that you can figure out an estimated number for your project.
Implementation Cost Structure & budget Implications
The first cost factor that you need to know is the implementation cost. In HL7 integration, you would require consulting, interface engines, and ongoing maintenance once it is implemented. Depending on the complexity of the software, data, and system network, it can be a costly affair. However, this varies from vendor to vendor.
For FHIR API integration, you need to leverage standard web development resources and cloud infrastructure. Though it seems to be less costly as compared to the HL7 integration services, setting up the cloud infrastructure can impact the cost. But again, the cost factor varies from vendor to vendor.
Moreover, the timeline differences in both HL7 integration services and FHIR API integration can impact the overall project cost and also resource allocation.
Long-term Total Cost of Ownership Comparison
If you are choosing a custom approach, you would also have to bear the total ownership cost. You see, HL7 maintenance cost includes specialized support from the technical team. Along with that, you would also have to look after the interface engine licensing and expertise retention for maintenance.
On the other hand, for FHIR API integration, you would have to bear the cost of API management and look after the security aspect and the scaling nature of cloud infrastructure.
Some of the most crucial things to look after in this are the vendor lock-in period and the flexibility implication that comes with the vendor.
Revenue & Efficiency Impact Analysis
HL7 has been a standard for a decade. It has a proven track record of supporting clinical workflows and optimizing them to improve your operational efficiency. However, using FHIR API integration can be a great choice to improve patient engagement and add a new revenue stream if you’re smart enough.
Both things have an indirect impact on your revenue. However, innovation acceleration and competitive advantage through modern data exchange capabilities can further improve efficiency and productivity.
Decision Framework & Implementation Roadmap
If you’ve made it till here, then you either have a decision ready in your mind or must be confused in some. If you have made the decision, then go ahead with it; if not, read along this segment to make a better decision.
Assessment Criteria for Standard Selection
The very first thing you need to do before even looking at the standards is assess your current technical infrastructure. And while doing this, assess your system in a way so that you can understand which standard my infrastructure is already compatible with.
Once done with that, check if the selected standard aligns with your practice’s goals or not. Check for each of the standard’s capabilities and limitations. And while you’re at it, check for resource availability, including budget, timeline, and expertise in your IT team.
Stakeholder Engagement & Decision-Making Process
Check with all the stakeholders and include your IT leadership for technical evaluation and risk assessment of which vendor to choose, which standard to include, etc. In this, have a critical understanding of how the workflow will be impacted along with its impact on user experience.
Implementation Planning & Risk Mitigation
Adopt and implement a phased approach for gradual standard. During this transition time, plan a parallel system operation so that your workflow and practice don’t get impacted. Also, have a change management plan and training plan in hand for each standard so that your users have a smooth transition from the existing system to a new system.
Conclusion
The choice between HL7 and FHIR clearly depends on the type of practice and specialty you are serving. Having said that, though, the choice is more like a technical decision. Positioning it correctly will enhance your operational efficiency, improve innovation capability, and give you a competitive advantage.
Moreover, both standards come with their own benefits and drawbacks, but choose the one that aligns with your practice’s current state, goals, and future plans. Last, but not least, make a decision based on your analysis and not the lucrative benefits that the standard is providing. And if you still have any doubts, then you know where to find us.
FAQs
- Can healthcare organizations use both HL7 and FHIR standards simultaneously?
Yes, healthcare organizations can and often do use both HL7 and FHIR standards simultaneously. Many organizations are in a transitional phase, maintaining legacy systems that rely on the widely adopted HL7 V2 standard while implementing the more modern, API-friendly FHIR standard for newer applications and data exchange needs. This hybrid approach allows for continued operations while progressively adopting enhanced interoperability.
- What are the typical timeline and resource requirements for implementing each standard?
Implementing a standard like ISO 9001, ISO 27001, or SOC 2 typically takes 6 to 18 months, depending on the organization’s size, complexity, and the standard’s scope. Resource requirements include a dedicated project manager, an implementation team with relevant expertise, employee training, and often the cost of external consultants or auditors and certification fees.
- How do HL7 and FHIR integration costs compare over a 5-year period?
Over a 5-year period, FHIR integration generally proves more cost-effective than HL7. While initial FHIR setup can be substantial, its use of modern web standards and APIs reduces development time and long-term maintenance costs. In contrast, HL7 often requires more specialized, expensive expertise for implementation and the ongoing management of rigid, custom interfaces.
- Which standard is better suited for small vs. large healthcare organizations?
For smaller healthcare organizations, FHIR (Fast Healthcare Interoperability Resources) is often more suitable. Its modern, web-based approach allows for easier and more cost-effective implementation.
Larger healthcare organizations may find that a combination of HL7v2 for existing systems, supplemented with FHIR for newer applications and DICOM for medical imaging, provides the necessary scalability and robustness to manage complex data exchange needs.
- How do regulatory requirements like the 21st Century Cures Act impact standard selection?
Regulatory requirements like the 21st Century Cures Act drive the selection of standards that ensure interoperability, data access, and patient control. They mandate the use of APIs and standardized data formats like FHIR, influencing how EHR systems are designed. Compliance becomes essential, pushing vendors to adopt universally accepted health IT standards to avoid information blocking.
- What are the key technical skills needed for implementing HL7 vs. FHIR integration?
Implementing HL7 integration requires skills in MLLP, parsing HL7 v2.x messages, interface engines (like Mirth Connect), and knowledge of clinical workflows. FHIR integration demands proficiency in RESTful APIs, JSON/XML, OAuth2, and an understanding of FHIR resources and profiles. Both require interoperability standards, knowledge, and familiarity with healthcare data exchange protocols.
- How do major EHR vendors support HL7 vs. FHIR integration differently?
Major EHR vendors support HL7 and FHIR differently based on system architecture and modernization. Traditional vendors like Epic and Cerner still rely heavily on HL7 v2 for legacy workflows but increasingly offer FHIR APIs for interoperability. Newer platforms, such as Athenahealth or Meditech Expanse, prioritize FHIR-first approaches, offering RESTful APIs to support modern, scalable integrations.
- What are the most common implementation challenges for each standard?
Common implementation challenges for each standard include:
- HL7: Managing legacy system compatibility and ensuring accurate message formatting.
- FHIR: Balancing flexibility with consistency and ensuring robust security for APIs.
- CDA: Complexity in document structuring and integrating narrative and coded data.
- DICOM: Handling large imaging data volumes and maintaining device interoperability.
- LOINC/SNOMED: Mapping clinical terms accurately and keeping terminology updates current.
- How do HL7 and FHIR standards support patient engagement and consumer health applications?
HL7 and FHIR standards enable seamless data exchange between healthcare systems and consumer health apps, promoting patient access to personal health records. FHIR’s modern, API-based approach supports mobile apps, wearables, and patient portals, empowering users with real-time health information and improving engagement, self-management, and informed decision-making in their care journey.
- What migration strategies work best for organizations transitioning from HL7 to FHIR?
Organizations transitioning from HL7 to FHIR benefit from phased migration, starting with a hybrid model that supports both standards. Implementing middleware or adapters ensures compatibility during the transition. Prioritizing high-impact use cases, training staff, and leveraging FHIR APIs incrementally help manage risks and ensure smoother adoption without disrupting existing workflows.
- How do security and privacy implementations differ between HL7 and FHIR?
HL7 v2 lacks standardized security, relying on external systems for encryption and authentication. Privacy controls are minimal and implementation-dependent. In contrast, FHIR includes built-in support for modern web-based security protocols like OAuth2 and HTTPS, enabling granular access control and better privacy handling. FHIR’s RESTful approach makes integrating secure, scalable systems easier.
- What role do cloud services play in HL7 vs. FHIR implementation strategies?
Cloud services enhance HL7 and FHIR implementation by offering scalable, secure infrastructure for data exchange. While HL7 relies on traditional, often on-premise systems, FHIR benefits more from cloud-native features like APIs, real-time access, and interoperability. Cloud platforms streamline integration, reduce costs, and accelerate deployment, making FHIR more adaptable to modern healthcare IT environments.
