Deconstructing the Interoperability Stack: A Comparative Technical Analysis of HL7 v2, CDA, and the FHIR Resource
Vibha Tiwari1,2, Shreecha Jha1, Rebakah Geddam2,3
1Centre for Artificial Intelligence, Madhav Institute of Technology and Science, Gwalior, India.
Computational and Structural Biotechnology Journal
|August 6, 2026
Summary
This review compares healthcare interoperability standards, from HL7 v2 and HL7 v3 to Fast Healthcare Interoperability Resources (FHIR). FHIR offers a scalable, implementation-focused foundation for modern digital health integration.
Area of Science:
- Health Informatics
- Computer Science
Background:
- Early electronic health record systems and HL7 v2 faced challenges with semantic incompleteness due to local customizations.
- HL7 v3 and Clinical Document Architecture aimed for greater interoperability but suffered from implementation complexity and rigidity.
Purpose of the Study:
- To technically compare the evolution of healthcare interoperability standards.
- To analyze architectural foundations, semantic models, and conformance approaches.
- To synthesize technical and semantic developments and address shortcomings of previous standards.
Main Methods:
- Structured scoping review comparing HL7 v2, HL7 v3/CDA, and FHIR.
- Analysis of architectural foundations, semantic models, interoperability mechanisms, and conformance.
- Comparative synthesis of technical and semantic evolution.
Main Results:
- HL7 v2 achieved wide adoption but lacked semantic consistency.
- HL7 v3/CDA faced adoption barriers due to complexity.
- Fast Healthcare Interoperability Resources (FHIR) introduced resource-oriented architecture, RESTful interactions, and profiling for improved interoperability.
Conclusions:
- FHIR addresses limitations of previous standards by offering a scalable, web-native approach.
- FHIR represents a leading foundation for contemporary healthcare interoperability and digital health integration.
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