07 May HL7, FHIR, and the HIE Reality: Why Interoperability Still Depends on Data Intelligence

Top Takeaways

• HL7 v2 remains foundational because it still powers much of healthcare’s day to day operational data exchange and continues to support core clinical workflows across the industry. 
• FHIR accelerated interoperability by making data exchange more practical, flexible, and developer friendly, allowing healthcare organizations to adopt API based integration faster than any previous HL7 standard. 
• Legacy standards are not disappearing as HL7 v2, CDA, and FHIR now coexist across healthcare environments and must be managed as part of a broader interoperability strategy. 
• HIEs are evolving beyond exchange as they take on larger roles in patient access, payer provider connectivity, quality reporting, and digital health infrastructure. 
• Interoperability still breaks down after exchange because moving data is not the same as making it complete, trusted, and usable across systems. 
• Data intelligence is now the missing layer between interoperability and action, helping organizations normalize, enrich, validate, and operationalize healthcare data at scale.

Healthcare interoperability has never lacked standards. What it has lacked is consistency in how those standards are implemented, governed, and operationalized across the healthcare ecosystem.

For nearly four decades, healthcare organizations have invested in interoperability through evolving HL7 standards, from v2 to v3 to FHIR. Each generation promised to improve data exchange. Each moved the industry forward in meaningful ways. But none solved the full problem on its own.

That is because interoperability has never been just about moving data. It has always been about making data usable.

Today, as FHIR accelerates modern API based exchange and health information exchanges (HIEs) expand their role in regional and national connectivity, the conversation is shifting again. The challenge is no longer whether healthcare data can move. It is whether that data can be trusted, normalized, and used at scale.

What HL7 v2, v3, and FHIR Actually Delivered

Healthcare interoperability is often framed as a progression from old standards to new ones, but the reality is more practical than linear.

HL7 v2 succeeded because it solved immediate operational needs. Introduced in 1988 and widely adopted in the 1990s, it became the backbone of hospital interoperability by supporting the transactions healthcare needed most, including admissions, discharges, transfers, orders, and results. It spread because it worked. Even today, HL7 v2 remains deeply embedded in hospital operations and continues to power much of healthcare’s day to day data movement.

HL7 v3 took a different approach. Released in 2005, it aimed to deliver semantic interoperability through a more rigorous and model driven architecture. Technically, it was sound. Operationally, it was too complex. Implementation was costly, adoption was slow, and most organizations stayed with v2 for transactional workflows.

The major exception was CDA and CCD, which successfully gained traction during the Meaningful Use era. These document-based standards helped organizations exchange clinical summaries and care records at scale, but they were adopted as documents, not as a replacement for v2 messaging.

FHIR changed the trajectory. First published in 2014, FHIR gained real traction by 2015 and 2016, far faster than any prior HL7 standard. It succeeded not because it was newer, but because it was more practical. API first architecture, incremental adoption, and developer familiarity allowed FHIR to deliver value early and scale naturally.

FHIR did not replace its predecessors by force. It learned from them.

Why Legacy Standards Are Not Going Away

There is a tendency in healthcare to treat interoperability standards as replacement cycles. In reality, they behave more like infrastructure layers. HL7 v2 is not disappearing, CDA remains firmly in place, and FHIR is not replacing either one. Instead, these standards are coexisting as part of healthcare’s evolving interoperability landscape.

This is the practical reality of healthcare interoperability. Legacy standards rarely vanish. They remain deeply embedded in workflows, interfaces, and core systems because they still serve critical functions. Much like COBOL in financial services, legacy healthcare standards persist because replacing them outright is often less practical than evolving around them.

That means healthcare organizations are not moving from HL7 to FHIR. They are moving into a world where v2, CCD, FHIR, claims, and unstructured content must all coexist. This is where interoperability becomes less about standards and more about orchestration.

Why HIEs Are at the Center of the Next Interoperability Phase

This shift is especially important for HIEs. For years, HIEs were primarily designed to move data across provider organizations and improve regional access to clinical information. That role remains important, but the expectations around HIEs are changing.

Today, HIEs are being asked to support much more than exchange. They are increasingly expected to enable:

• Longitudinal patient records
• Patient access and digital front doors
• Public health reporting
• Payer provider data exchange
• Quality measurement
• Care gap closure
• FHIR based app ecosystems

 

As CMS pushes interoperability beyond policy and into execution, HIEs are becoming foundational infrastructure for modern digital health exchange. The CMS Health Tech Ecosystem and broader FHIR based interoperability initiatives are reinforcing this shift by moving healthcare toward app-based access, API driven exchange, and more connected care models.

But HIEs face the same challenge as every other interoperability stakeholder. Moving data is not the same as making it usable.

The Missing Layer Between Exchange and Utility

This is where many interoperability strategies still break down. Healthcare has made enormous progress in connectivity. Data can move across systems faster than ever. But once it arrives, it is often incomplete, duplicated, inconsistent, or difficult to use.

This is not simply a transport problem, but a data intelligence problem. While FHIR can move a resource, HL7 can move a message, and CCD can move a document, none of these standards alone ensure that data is complete, trusted, or usable once it arrives.

None of them, by themselves, guarantee:

• Patient identity resolution
• Terminology normalization
• Duplicate reconciliation
• Clinical concept extraction
• Completeness validation
• Downstream usability

 

This is the missing layer in modern interoperability. It is not enough to exchange data. Organizations must also transform it into something trustworthy and actionable.

Why Data Intelligence Matters More Than the Format

This is where interoperability becomes operational, and where IMAT Intelligence is built to bridge the gap between data exchange and data utility.

Rather than forcing healthcare organizations to choose between legacy and modern standards, IMAT enables them to work across all of them. IMAT ingests and normalizes structured and unstructured data from across the healthcare ecosystem, including HL7 messages, XML, CCDs, FHIR resources, claims, radiology reports, flat files, and dictated clinical summaries.

IMAT transforms fragmented data into a usable, longitudinal patient record that supports interoperability, clinical decision support, quality reporting, patient safety, coding, and population health.

That means organizations are not just exchanging data. They are creating data utility.

The Future of Interoperability Is Not Just FHIR

FHIR is the future of modern healthcare interoperability. But FHIR alone is not the future of healthcare interoperability success.

The next phase of interoperability will not be defined by which standard wins. It will be defined by which organizations can make data usable across all of them.

That means:

• Supporting legacy and modern exchange simultaneously
• Normalizing data across formats
• Enriching incomplete records
• Making data trustworthy enough for analytics, AI, and care decisions
• Enabling HIEs to move from connectivity to intelligence

 

Healthcare does not need another interoperability format. What it needs is a more effective way to make interoperable data usable, trusted, and actionable at scale.

This is especially critical for HIEs, which increasingly need to serve as more than exchange hubs. To support modern interoperability, HIEs must evolve into intelligence layers that can normalize data across sources, enrich records, and deliver trusted information downstream to providers, payers, public health agencies, and digital applications.

Contact IMAT Solutions to learn how IMAT Intelligence can help you operationalize interoperability with trusted, usable, and actionable healthcare data.

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About the Author
Mark Coetzer is VP of Business Development at IMAT Solutions, with more than 30 years of technology experience and a decade dedicated to healthcare. He brings deep expertise in clinical data integration, interoperability, and population health, and is passionate about helping organizations build trusted data foundations for better care and smarter outcomes.

Additional Insights from Mark Coetzer

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