The healthcare landscape has been radically transformed by digital technology — from electronic health records (EHRs) to mobile applications and cloud, web-enabled devices have transformed the way we exchange health information and deliver patient care. As new digital technologies are integrated into our healthcare infrastructure, Federal and commercial healthcare providers are increasingly concerned with interoperability and creating a seamless, secure flow of accurate health data information between disparate systems.
For over 30 years, Health Level Seven International (HL7) has developed healthcare information exchange and related standards to automate healthcare data sharing, integration, and retrieval. The organization has produced a number of open standards over the years, such as HL7 v2, HL7 v3, the Reference Information Model (RIM), and Clinical Document Architecture (CDA). However, despite wide adoption, these standards had limited flexibility and inconsistent implementations and were not cost-efficient.
To address interoperability challenges, HL7 created Fast Healthcare Interoperability Resources, or FHIR (pronounced “fire”) in 2014 to combine open-source technologies such as API-enabled web services (e.g., REST) with the best features of previous HL7 standards. In layman’s terms, FHIR standardizes the electronic exchange of healthcare data so providers can quickly and securely share patient data across multiple platforms, including mobile phone applications, cloud communications, and EHRs. After gaining extensive support from major EHR vendors like Cerner, Epic, and athenahealth, FHIR is now the gold standard for healthcare interoperability.
How does FHIR work?
FHIR is a web-based standard built around the concept of “resources,” or basic units of interoperability and modular components that can be combined and incorporated into existing systems to resolve clinical, administrative and infrastructural problems in healthcare. FHIR standardizes these resources by creating standard URLs for packets of information, eliminating the need to exchange physical documentation or data required by past models. Much like a URL, FHIR has a unique identifier attached to each resource, enabling providers to access the correct information from any device or application. In this way, FHIR creates a seamless transfer of patient data, pointing providers and administrators to the correct and most up-to-date version without having to waste time searching for information.
Major FHIR benefits
To help clients reach their modernization and standardization goals while maximizing business value, Halfaker, an SAIC company, builds and integrates HL7’s FHIR into our innovative solutions. The FHIR standard presents several benefits from developer and business perspectives.
- Developer benefits. Because FHIR leverages HL7’s previously defined patterns and best practices, developers can easily implement the exchange standard to build user-friendly applications without intimate knowledge of previous HL7 standards. As a web-based protocol, developers can use FHIR to easily plug applications into an EHR system and feed information directly into existing provider workflows.
- Business benefits. FHIR enhances interoperability between disparate systems while protecting information integrity and accelerating healthcare delivery speed with readily accessible data. More flexible than its HL7 predecessors, FHIR can be used alone or in conjunction with other standards to build customized applications that meet specific healthcare provider needs. Healthcare organizations can leverage FHIR to build and integrate applications to address a wide variety of use cases, including increasing patient engagement with mobile applications, developing robust population health management programs, and automating clinical decision support.
Key guidelines for developers
To fully take advantage of FHIR’s capabilities, developers should follow these key guidelines:
- Always deploy the same versions of FHIR to each system and implement all available FHIR APIs for maximum interoperability. Leveraging open-source and commercial tools and libraries (e.g., ClinFHIR tool suite, Forge, FHIR NotePad++ plugin, Postman, and Simplifier.net) can accelerate data profiling and API creation
- Reference implementation guides, best practices, and use cases established by the Da Vinci Project, a joint initiative led by HL7 and healthcare providers to lay the groundwork for standard FHIR implementation
- Conduct daily testing using tools such as Crucible, Inferno and Touchstone for greater compliance with industry standards, while integrating continuous improvement principles into the development cycle. This speeds up development and ensures consistent FHIR implementations
The future of FHIR
HL7 continues evolving FHIR to boost patient-centered, data-driven healthcare in the United States. FHIR R5, slated for release in Q3 2020, will expand FHIR capabilities and features. FHIR R5 will build on FHIR R4 by:
- Moving more resources to a normative state
- Improving support for applications using multiple FHIR releases seamlessly
- Supporting multiple languages and federated servers
- Adding new facilities focused on migrating data to and from HL7 v2 messages and CDA documents.
Other future enhancements beyond FHIR R5 include continued development of adjunct specifications (e.g., SMART App Launch and FHIRCast) to enhance workflows and improve integration.