Healthcare Interoperability: HL7 vs FHIR in Emerging Markets (2026)

Interoperability — the ability for different healthcare systems to share information with each other — is probably the most important technical challenge facing the healthcare sector in Latin America. While developed countries have been working on this for decades, many institutions in LATAM still operate with isolated systems that don't communicate.

Two standards dominate the conversation: HL7 v2 (the veteran) and FHIR (the modern one). Which should you implement? Are they compatible? Do you need both?

What is HL7 v2 and why is it still relevant?

HL7 v2 (Health Level 7 version 2) is a messaging standard for clinical data exchange created in 1987. Yes, it's almost 40 years old. And it's still the most widely implemented standard in the world.

How it works:

• Defines message formats for clinical events: patient admission (ADT), study order (ORM), lab result (ORU), etc.
• Messages are transmitted between systems point-to-point, typically via TCP/IP.
• Each message segment has predefined fields (patient name, diagnosis, result, etc.).

Why it's still relevant:

• It's the standard already implemented by most medical equipment, PACS, and LIS on the market.
• It's mature, well-documented, and widely supported by vendors.
• It works. It's not elegant, but it works.

Limitations:

• It's complex to implement and each implementation is slightly different (HL7 interface "negotiations" between vendors are notorious).
• It wasn't designed for web or modern APIs.
• It doesn't support queries well — it only sends messages when an event occurs.

What is FHIR and why is it the future?

FHIR (Fast Healthcare Interoperability Resources) is the modern standard from HL7 International, designed from scratch for the web world.

How it works:

• Defines resources (Patient, Observation, DiagnosticReport, Encounter, etc.) instead of messages.
• Each resource has a URL and is accessed via standard REST API (GET, POST, PUT, DELETE).
• Data is exchanged in JSON or XML.

Advantages over HL7 v2:

HL7 v2 vs FHIR: which to choose?

The short answer: it's not a binary choice. In the LATAM reality, most institutions will need both during a transition period.

Use HL7 v2 when:

• You connect with medical equipment (lab analyzers, DICOM modalities, monitors) that only speaks HL7 v2.
• You integrate with legacy systems (old PACS, HIS, LIS) that don't support FHIR.
• Your integration is point-to-point and you don't need open APIs.

Use FHIR when:

• You develop new applications (patient portals, mobile apps, dashboards).
• You need open APIs for third parties to connect with your system.
• You integrate with modern systems that already support FHIR.
• You need to comply with regulations requiring FHIR-based interoperability.

The pragmatic strategy:

Implement a system that supports both standards and acts as a bridge between the legacy world (HL7 v2) and the modern world (FHIR). This way you don't need to replace all your equipment at once, but can modernize gradually.

The state of interoperability in LATAM

The reality in Latin America is mixed:

Clear trend: The region is moving toward FHIR, but HL7 v2 will remain present for at least 5-10 years due to the installed base of legacy equipment.

Common mistakes when implementing interoperability

1. Believing that "connecting" = "interoperating"

Just because two systems exchange data doesn't mean they understand each other. If the HIS sends diagnoses in free text and the receiving system expects ICD-10 codes, the "integration" doesn't generate real value.

2. Underestimating the mapping effort

80% of the work in an HL7 integration isn't technical — it's mapping fields from one system to another. Does the HIS "diagnosis" field correspond to the PACS "diagnosis" field? Do they use the same coding? The same date formats? Mapping is tedious but critical.

3. Not having an interoperability owner

Integrations without a clear owner degrade over time. Each system update can silently break the integration. Someone must monitor and maintain the connections.

4. Implementing custom integration instead of using standards

If a provider offers integration via flat files, shared databases, or proprietary APIs instead of HL7/FHIR, you're creating technical debt that will be costly to maintain.

How Davix solves interoperability

Davix addresses interoperability from two fronts:

1. Native integration between modules: If you use PACS + HIS + LIS from Davix, you don't need integrations — data flows natively between modules because they share the same platform. See how it works.

2. Open standards for external systems: If you need to connect Davix with third-party systems, it supports:

• HL7 v2 for medical equipment and legacy systems
• FHIR for modern applications and regulatory compliance
• DICOM for imaging equipment
• REST APIs for custom integrations

Frequently asked questions

Do I need to hire an HL7 specialist to integrate my systems?

If you use a unified platform like Davix, no. Integrations between Davix modules don't require HL7 configuration. For integrations with external systems, the Davix team handles configuration as part of the implementation process.

Will FHIR replace HL7 v2?

In the long run, probably yes. But the process will take years because the installed base of HL7 v2 equipment is enormous. The right strategy is to support both standards and migrate gradually.

Is interoperability expensive?

It depends on the approach. Integrating 3 separate systems with HL7 can cost $10,000–$30,000 USD. Using a unified platform that already integrates PACS, HIS, and LIS costs $0 in integration. Interoperability with external systems is included in Davix plans.

Does my country require a specific standard?

It depends on the country. Brazil requires FHIR for RNDS. Chile recommends it. Most LATAM countries are in transition. Check the table in this article and verify with your health authority for specific requirements.

Conclusion

Interoperability is not an IT project — it's an enabler of better patient care. Key takeaways:

• HL7 v2 remains essential for medical equipment and legacy systems.
• FHIR is the future and already the present in Brazil and other advanced markets.
• You'll need both during the transition. Choose systems that support both.
• The best integration is the one you don't need to build: a unified platform eliminates the need to integrate.
• Davix supports HL7, FHIR, DICOM, and REST APIs to cover all scenarios.

Check Davix pricing or schedule a demo to see how it integrates with your current ecosystem.