HL7 v2 pipes run hospital interfaces today (ADT, orders, results); FHIR's REST/JSON resources power modern APIs and patient-access mandates — production integration usually bridges both.
Resources (Patient, Observation, Encounter) with references between them, SMART on FHIR for auth into EHR contexts, and US Core profiles as the interoperability floor — the standard is readable; the implementations vary.
Site-specific v2 variants, terminology mapping (codes differing by system), and EHR sandbox behavior diverging from production — interface engines and integration platforms exist because point-to-point breaks first.
PHI flowing through interfaces inherits HIPAA obligations — BAAs, audit trails, and minimum-necessary design apply to the pipes, not just the apps.
Skipping the discipline this article describes until an incident, audit, or stalled project forces it — every practice above is cheaper adopted early than retrofitted under pressure.
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