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HL7 Integration in Healthcare Systems: Challenges and Ways to Solve

Paul Kovalenko Paul Kovalenko | May 22, 2023 | 11 min

Integration in the healthcare industry presents a number of challenges considering how inconsistent interoperability between medical systems is. This is one of the main reasons why the process of data transfer is so slow and unreliable, making it quite unwelcome by healthcare providers.

This issue is actively being solved by the HL7 (Health Level 7), an organization that offers standardization for interoperability in health tech, something which will cut the national healthcare costs by $30 billion. In this article, we are going to explore what the Health Level 7 (HL7) standard is and the benefits of HL7. We’ll also explain how HL7 API tackled some of its challenges.

What is HL7 Integration?

HL7 integration is the process of connecting and exchanging healthcare data between different systems using the Health Level 7 (HL7) standard. 

This helps to create a unified inter-communication language so that different medical systems like electronic health records (EHR), hospital information systems (HIS), electronic medical records (EMR), radiology information systems (RIS), and lab information systems (LIS) can all communicate together seamlessly for improved healthcare delivery.
Today, many different medical organizations are interested in implementing HL7 integration, and some of them include hospitals, clinics, health insurers, EHR vendors, health information exchanges (HIEs), medical equipment manufacturers, and labs. Any organization that deals with patient health data could benefit from HL7 integration services.

Role of HL7 Standards for Healthcare Providers

HL7 V2 was created back in 1989 to tackle interoperability issues. It streamlined communication between different systems with various functions: electronic medical record (EMR) systems, hospital information systems, radiology and picture archiving systems, laboratory information systems, billing systems, etc.

Before this data formatting standard appeared, it was difficult to share patient information between different parts of the healthcare process (like care – pharmacy – billing). It was also a challenge for patients to transfer between different specialists and hospitals since they either had to carry paperwork with them or create a new medical record and go through examinations and testing again. Data sharing was a nightmare for all parties in the healthcare industry.

The standard defines 80% of the interface, while the other 20% is left for customization: local data variations that were introduced by optional fields, extra messages, etc. HL7 V2 used ASCII-based (American Standard Code for Information Interchange) messages with encoding rules, groupings, cardinality, and the default character set to reach the standard look and meaning of messages.

The standard was a massive step towards interoperability, and developers could avoid a chunk of manual interface coding. Currently, HL7 V2 is adopted by 95% of healthcare institutions across the US.

However, it was still not perfect when HL7 V3 was introduced in 2005, backed by expertise from governmental and medical structures. It allowed less customization, making it more a standard rather than an implication, provided methodologies for data modeling, created inconsistencies and difficulties in understanding, and defined message and applications roles. The standard was not compatible with V2, demanded an entire system rebuilt, and still had its imperfections. Therefore, only a small percentage of healthcare institutions actually embraced the standard.

Traditional HL7 Integration Challenges

Being developed a third of a century ago, HL7 integration and data interoperability were not perfect. So, it still poses numerous challenges for data interoperability in healthcare systems.

There Is Too Much Variance

Traditional HL7 integration offers too much room for customization and a lot of unspecified data semantics, which results in data variance. Basically, different values may have different meanings across disparate systems. For example, value “3” may be used for smokers in one system and former smokers in the other. It results in misinformation and confusion about a patient’s health which can potentially lead to the worst imaginable outcomes.

As a result, providers had to find a specific solution for every healthcare institution and system.

Complex Interface Programming

In order to connect two systems, one had to do a lot of programming and know both systems perfectly. Surely, it was way before HL7 software integration appeared, but it still took a lot of effort and time. If you wanted to connect more than 2 systems, you would have to spend a significant amount of time to do so. You also had to constantly monitor and test the interfaces to see if there were any disturbances.

It Is Based on an Expert’s Hypothesis

Traditional HL7 data integration was developed based on recommendations from clinical interface specialists. It was mostly about “how it is supposed to work and to help” rather than asking real end-users about the problems that they face. The complaints of the latter were heard only while creating HL7 integration software, but at that point, it was too late since all systems already adopted the second version. As a result, hypotheses were too detached from reality and did not manage to tackle the majority of issues.

It Can’t Go Beyond Clinical Apps

HL7 V2 was developed for clinical applications, especially internal ones. It was not introduced with the Internet in mind and did not predict the future interest of patients in their own health and analytics power. Therefore, it does not foresee API interoperability with healthy lifestyle apps, telemedicine, or any patient-facing app and apps that provide analytics for the full view of the clinic and its performance. They do not support data types used by these applications, which require a lot of effort for a fragile connection, which most likely results in them giving up.

You Can Not Ask for Information On-Demand

In HL7 V2, you have to subscribe to a feed where all information is shared, no matter whether you need it at the moment or not. It resulted in a big scope of sending and receiving unneeded information and privacy concerns since the system got access to more protected health information than was actually required.

Should You Integrate FHIR API with HL7?

Fast Healthcare Interoperability Resources (FHIR), a recent standard, simplifies the integration and interoperability of EHRs using APIs. It leverages web technologies like RESTful APIs, XML, JSON, and RDF to manage the ever-increasing complexities of healthcare data, unlike HL7, which uses just XML.

HL7 integration via APIs using FHIR will make it even easier for health data to be exchanged quickly, efficiently, and seamlessly. This means improved interoperability, scalability, and future readiness, improved workflow and automation, and enhanced patient care.

If you already use HL7 integration but need to improve data interoperability, then FHIR is for you. Learn more about meeting this new standard.

Benefits of FHIR API for HL7 Integration

FHIR API was introduced by HL7 in 2011 and has become a truly modern solution for HL7 & EMR system integration. It is based on web standards that allow different systems to communicate with each other, although they “speak” different languages. You do not have to know the specifics of the other system or connect the interfaces manually between the two. Moreover, it operates modern technologies like HTTPS, REST, XML, JSON, ATOM, and OAuth that make the integration process much easier and faster.

HL7 FHIR API solves many tasks that were either too complicated or impossible in healthcare before, such as:

Letting Patients Control Their Health

According to a survey, 87% of patients would like to have access to such medical data as X-rays in their EHRs. Making this data available to patients brings lots of benefits. People would have an opportunity to understand their condition better and to easily access their prescriptions in case they forgot how to take their medication. They could also access their dieting restrictions, find and fix any errors in their record, and make more informed decisions about their health overall.

HL7 FHIR integration makes sure that software developers can easily integrate health data within any patient-facing app. Big companies like Apple, Google, Amazon, and Microsoft are already working with the FHIR API to give users access to their health data.

Giving Resources to Researchers

Health data has a lot of value. It allows you to understand public health and its problems better, see how treatments work for different categories of patients, and train AI/machine learning to diagnose better, suggest treatment, or spot financial problems in the healthcare industry.

FHIR allows for the easy flow of well-structured data that is perfect for analysis. You also can pull it from numerous sources, which boosts the quantity and diversity of data. High-quality and big quantities of data are conditions for fruitful research.

Health Data on Your Mobile Device

FHIR offers to integrate HL7 data from EHR with any system or device, meaning that medical staff are free to use their mobile devices and are not bound to computers anymore. It is a step forward for better and faster communication with patients and doctors from other departments and hospitals. Doctors can also avoid duplicate paper records by simply filling out updates about a patient’s health at any point of care, be it their room, emergency hall, or doctor’s office. The changes will be made available to anyone needing the record almost instantly. Lastly, it also facilitates decision-making, as you can get a full overview of a patient’s health history from anywhere to make a more informed decision.

Easy Integration with Telehealth Apps

Telehealth is a huge trend in the healthcare industry, considering how many patients live in remote locations and how many can’t commute to the hospitals because of work and traffic; the COVID pandemic is not helping with any of these matters. This industry experienced a 154% increase in March of 2020 in comparison with the same period of the previous year and is still growing.

EHR to HL7 FHIR integration allows developers to easily integrate medical data into the telehealth app, allowing doctors to get the full overview of the patient’s examinations and lab results and to write updates about the meeting in real time.

Need help establishing data integration with the HL7 FHIR API?
Langate can help

HL7 Integration Use Cases

The following use cases of HL7 integration will help you gain a clearer understanding of how the standard applies in real-world scenarios.

Process Automation

HL7 integration automates healthcare processes like data entry, lab tests, prescriptions, and order processing, reducing manual effort, improving patient care and customer service, and reducing errors.

Patient EHR Management

Integrating EHRs with HL7 systems enables better access and streamlined management of patient data, ensuring accurate and up-to-date information for comprehensive care.

Information Exchange between Healthcare Providers

HL7 interface integration engine allows secure EHR migration or exchange between healthcare organizations, leading to better healthcare decisions, improved care delivery, and patient outcomes.

Information Exchange with Regulators

It also streamlines sharing of information and data with regulatory bodies, ensuring compliance and supporting reporting requirements.

Shift Management for Healthcare Workers

Connecting systems through using of HL7 integration platforms helps healthcare providers track staff availability, assign shifts, and manage attendance, ensuring the right staff for patient needs and streamlined shift management.

Patient Scheduling, Reminders, and Services

HL7 integration improves patient services like scheduling, reminders, and appointment-related tasks, facilitating seamless communication between patients and healthcare providers.

Strategy for HL7 Integration: 3 Stages of Implementation 

If you’re thinking of how to integrate HL7 standards in your healthcare organization, there are a number of steps to follow that will make the process a success. These implementation stages are.

Plan the Interface

The first approach to HL7 integration is to plan the interface design. Identify the specific interfaces that need to be implemented based on the requirements of the healthcare system. 

Some common message types include: 

  • ADT: Admission, discharge, transfer
  • BAR: Billing account record
  • DFT: Detailed financial transaction
  • MDM: Medical document management
  • MFN: Master files notification
  • ORM: Orders
  • ORU: Observation results
  • SIU: Scheduling

The relevant personnel should be involved in this decision-making process.

Build the Interface

Once the interface design is planned, proceed to build the interface. This step is further subdivided into:

  • Execution: During the execution phase, the development team works on creating the necessary port along with their respective content.
  • Interface Build: The interface is built based on the defined requirements and specifications. Remember to account for field locations in this design phase.
  • Testing: Thorough testing of the interface is crucial to identify and resolve any potential issues or errors.

Final Testing and Validation

During this step, the HL7 interface undergoes comprehensive testing and validation to ensure reliability and accuracy. Testing typically involves the following two steps.

  • Unit Testing: Unit testing is done to verify the functionality of the point-to-point interface and catch any errors missed in the interface design stage.
  • Integrated Testing: Integrated testing is performed to validate the end-to-end data exchange process between the healthcare systems involved in the integration.

How Can We Help?

Langate has been working in the health tech vertical for more than 20 years, and we have been utilizing FHIR API for a really long time. If you want to create a patient-facing or telehealth app, we are here to help you build it and find the best HL7 integration strategies for your institution. Our professional developers, designers, testers, and project managers are ready to assist you at every step of creating a modern, useful, and HIPAA-compliant solution.

Our HL7 Experience

We carried out a healthcare data integration project with Approved Admissions, a premier provider of insurance verification services. They pulled data sources from hundreds of institutions around the US, and it resulted in errors and duplicates. We have created a data interoperability solution with a translator for most data protocols and automatic notifications about errors. As a result, they are able to manage 1 million transactions a day through our data integration solution with almost no errors.


Data integration is much easier with the FHIR API and opens more room for personal electronic records, efficient EHR/EMR utilization through mobile devices, and research for better machine learning and treatment understanding. The API truly facilitated interoperability, unlike the previous and slightly obsolete HL7 V2. 

If you want to make that leap toward interoperability, do not hesitate to reach out to Langate. We have the HL7 integration expertise to help you build and develop HL7 EMR integration using the modern FHIR API solution.

Frequently Asked Questions

What are the features of HL7 integration?

The typical features of HL7 integration include standardization, data exchange, interoperability, workflow automation, scalability, and patient data management.

What are the advantages of HL7 integration?

HL7 provides an uninterrupted flow of electronic health data. This enhances communication between medical facilities and improves the quality of care and patient experience.

What is the difference between FHIR and HL7 integration?

FHIR, a specific standard in the HL7 framework, simplifies healthcare data exchange and interoperability. Unlike HL7 standards, though, FHIR supports RESTful APIs and open web technologies for enhanced connectivity and flexibility.

Can HL7 integration work with cloud-based applications?

Yes, it can. HL7 integration tools that work with web-based APIs give you the benefit of external connectivity with cloud-based applications to facilitate a secure and seamless exchange of clinical and administrative data.

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