What standards do hospitals use to route results to outside clinicians?

Four come up most: HL7 v2 (the long-established messaging standard for results, orders and admissions), FHIR (the modern API-based standard for exchanging discrete data), Direct secure messaging (encrypted clinician-to-clinician delivery, like secure email for healthcare), and TEFCA/QHIN (the framework and networks for nationwide exchange). Most hospitals use several at once.

What's the difference between HL7 v2 and FHIR?

HL7 v2 is the older, message-based standard that still carries a huge share of real-world clinical data — lab results, orders, ADT. FHIR is the newer standard built around web APIs and discrete resources, designed to make data easier to request and combine. They coexist: HL7 v2 moves a lot of today's data, and FHIR is increasingly used for app-style access. A practical portal speaks both.

What is TEFCA and a QHIN?

TEFCA — the Trusted Exchange Framework and Common Agreement — is a US framework establishing common rules for nationwide health-data exchange. QHINs (Qualified Health Information Networks) are the networks designated under it to connect participants. Together they aim to make cross-organization exchange more uniform across the country.

Does a community physician portal replace these standards?

No — it uses them. The standards move the data; the portal is where a referring physician reads it. A portal built on HL7 v2 and FHIR can draw the right results for the right physician from the hospital's systems and present them read-only, without tying the hospital or the physician to a single EMR.

Referrals & physician engagement

Results routing: HL7 v2, FHIR, Direct, and TEFCA

Updated June 2026 · Reviewed by David Higginson, CHIME Innovator of the Year

"Interoperability" covers a stack of different standards that do different jobs. Here's the plain-English version of the four that matter for getting results to referring physicians.

Results routing is the movement of clinical results and related data from a hospital to outside clinicians using interoperability standards. The main ones: HL7 v2 and FHIR for system-to-system data exchange, Direct secure messaging for clinician-to-clinician delivery, and TEFCA/QHIN for nationwide exchange. They aren't competitors — they're layers that do different jobs, and most hospitals use several together.

The four standards, briefly

HL7 v2. The long-established messaging standard that still carries an enormous share of real-world clinical data — lab results, orders, admissions/discharges. Workhorse, not glamorous.
FHIR. The modern, API-based standard built around discrete "resources," designed to make data easier to request and combine — increasingly used for app-style, on-demand access.
Direct secure messaging. Encrypted, clinician-to-clinician delivery — effectively secure email for healthcare — good for pushing a result to a named recipient.
TEFCA / QHIN. The US framework (Trusted Exchange Framework and Common Agreement) and the designated networks (Qualified Health Information Networks) that aim to standardize nationwide exchange.

How they fit together

Think of it as push versus pull versus reach. HL7 v2 and FHIR move data between systems; Direct pushes a result to a specific clinician; TEFCA/QHIN extends reach across the country. None of them, by itself, gives a community physician a tidy, governed view of their own patients — that's the job of a portal that sits on top of these standards and presents the data read-only.

Why standards-based beats EMR-specific

A portal built on open standards can serve community physicians regardless of which EMR they or the hospital run. It extends the systems already in place rather than locking everyone into one vendor's ecosystem — the difference between reaching every referring physician and only the ones inside your EHR. (See read-only record access for community physicians.)

Where this fits at Bluefish

HealthPoint is built on HL7 v2 and FHIR — proven in production on Altera Sunrise, and standards-based for connectivity to other major EMRs, including Epic, via HL7 and FHIR. It uses these standards to give referring physicians a read-only view of their own patients and their referral status. Start with what a community physician portal is.

Sources: HealthIT.gov (ONC) — standards · HL7 International — standards · The Sequoia Project — TEFCA.

Frequently asked questions

What standards do hospitals use to route results to outside clinicians?: Four come up most: HL7 v2 (the long-established messaging standard for results, orders and admissions), FHIR (the modern API-based standard for exchanging discrete data), Direct secure messaging (encrypted clinician-to-clinician delivery, like secure email for healthcare), and TEFCA/QHIN (the framework and networks for nationwide exchange). Most hospitals use several at once.
What's the difference between HL7 v2 and FHIR?: HL7 v2 is the older, message-based standard that still carries a huge share of real-world clinical data — lab results, orders, ADT. FHIR is the newer standard built around web APIs and discrete resources, designed to make data easier to request and combine. They coexist: HL7 v2 moves a lot of today's data, and FHIR is increasingly used for app-style access. A practical portal speaks both.
What is TEFCA and a QHIN?: TEFCA — the Trusted Exchange Framework and Common Agreement — is a US framework establishing common rules for nationwide health-data exchange. QHINs (Qualified Health Information Networks) are the networks designated under it to connect participants. Together they aim to make cross-organization exchange more uniform across the country.
Does a community physician portal replace these standards?: No — it uses them. The standards move the data; the portal is where a referring physician reads it. A portal built on HL7 v2 and FHIR can draw the right results for the right physician from the hospital's systems and present them read-only, without tying the hospital or the physician to a single EMR.