FHIR-Native Architecture: Building Healthcare IT for True Interoperability

FHIR-Native by Design: Why Legacy System Conversions Can't Compete with Purpose-Built Interoperability

As healthcare systems race to meet 21st Century Cures Act mandates, a critical question emerges: retrofit or rebuild? Mike O'Neill, CEO of MedicaSoft, explains why FHIR-native architecture delivers fundamentally different interoperability outcomes than legacy systems with API layers bolted on. This conversation cuts through vendor marketing to examine the structural, semantic, and operational advantages of building healthcare IT from the ground up on HL7 FHIR standards.

O'Neill draws on extensive experience leading P&L, engineering, and operations across healthcare IT startups and public companies to explain what "FHIR-native" actually means in practice—and why it matters for CIOs evaluating vendor claims. Learn how purpose-built FHIR architecture eliminates middleware complexity, reduces integration costs, and enables real-time clinical data exchange that retrofitted systems struggle to deliver.

• Technical and operational differences between FHIR-native systems and legacy platforms with FHIR APIs
• Cost implications of middleware elimination versus ongoing translation layer maintenance
• How FHIR-native architecture impacts system performance, vendor lock-in, and future scalability
• Regulatory compliance advantages under 21st Century Cures Act requirements

Mike O'Neill, CEO, MedicaSoft

Megan Antonelli, Founder & CEO, HealthIMPACT Live