Introduction to FHIR and Its Importance in U.S. Healthcare
Claude Louis-Charles, PhD
Introduction
The digitization of healthcare records in the U.S. healthcare system has tremendously evolved. The process allows easy availability, accessibility, and interpretation of patients’ data within the healthcare environment. The digitization of healthcare data also ensures data structuring and standardization, fostering automated clinical decision-making and various programmed processes central to optimal patient outcomes. Health Level Seven International (HL7) has demonstrated great commitment to addressing healthcare records digitization challenges by developing healthcare data transfer and data modeling principles for the past two decades. FHIR (Fast Healthcare Interoperability Resources) is HL7’s new healthcare information exchange standard founded on novel industry techniques but guided by decades of experiences gained through the implementation of preceding standards, including CDA (Clinical Document Architecture), HL7 V2 (Version 2), and HL7 V3 (Version 3). While FHIR can be used independently, it can also work in combination with HL7’s previous standards. As HL7's new standard for the electronic exchange of healthcare data, FHIR is designed to simplify healthcare information transfer without compromising data integrity. It has internal traceability mechanisms that ensure compliance with HL7’s previous standards. FHIR utilizes current conjectural and practical models to create a coherent, easily implementable, and robust process of sharing information among various healthcare applications based on the applicable federal regulations.
Overview of the FHIR Standard
The FHIR standard describes the process of sharing healthcare data between different healthcare applications irrespective of the associated data storage mechanisms. It enables safe access to healthcare data, including administrative and clinical information, to authorized persons for optimal patient care outcomes (HL7; Ayaz et al. 2). Using a collaborative approach, HL7 commenced the development of FHIR in 2012 in reaction to the elevated market demand for quicker, simpler, and enhanced methods of sharing the increasing large volumes of healthcare data (HL7; Boussadi and Zapletal 1). This upsurge in new healthcare information, coupled with the evolving applications economy, presented the need for patients and healthcare providers to have real-time access to healthcare data using advanced communication tools and standards.
FHIR is founded on internet standards commonly used by various non-healthcare sectors. Specifically, these standards encompass the REST model, which explains how resources can be exchanged effortlessly (Ayaz et al. 3; HL7; Rosa et al. 525). The FHIR standard offers a broad range of benefits to software developers, including easy and quick implementation, unrestricted use, interoperability, and a stable underpinning on web standards, including HTTP, XML, OAuth, and JSON (Rosa et al. 525). Moreover, FHIR has a human-decipherable serialization format and succinct, easily-understood specifications (Boussadi and Zapletal 2). Since its launching, the FHIR standard has been adopted by healthcare software implementers globally due to its simplicity and efficacy (HL7; Ayaz et al. 3). This widespread use has resulted in an extensive online FHIR community.
The FHIR's fundamental building block is the resource. A resource describes individual data units or shareable content (HL7; Shah 1). Every resource has a human-decipherable component, a shared dataset, and a shared approach to data description and display (Joao et al. 1250). The theory behind FHIR is to develop foundational resources that, either independently or in combination, fulfil the larger proportion of common-use scenarios. These resources are designed to describe the data edifice and contents for the central data set exchanged by most applications (HL7). The FHIR standard modeling is founded on a composition method rather than the constraint approach used for modeling other HL7 standards, such as HL7 V3 (HL7; Shah 2). Specific use scenarios under FHIR are often executed by integrating resources using resource references (Boussadi and Zapletal 2). While one resource could be utilized independently for a specific use case, resources are mostly pooled and tailored to satisfy the specific needs of the use case. Examples of FHIR resources include capability statements and structure definition (HL7; Joao et al. 1254). Each resource has information aspects required for its specific use cases and is connected to pertinent data in other resources.
The FHIR's design is principally founded on the need to allow interoperability through properly organised information models that utilize straightforward and efficient data-sharing processes. To meet this requirement, FHIR adopted various principles, including implementability, reuse, fidelity, usability, and performance (Vorisek et al. 2). The reuse principle requires FHIR resources to satisfy the shared healthcare needs to prevent resource set over-complication and redundancy (Vorisek et al. 2; HL7). FHIR allows various customizations, including extensions, to enable the adaptation of resources to specific use scenarios. Moreover, FHIR resources are interlinked to enable the development of sophisticated structures (HL7). The performance principle involves constructing simpler resources for easy sharing, understanding, and implementation by developers (HL7; Joao et al. 1251). The usability principle encompasses developing resources that are effortlessly interpreted by both non-specialized users and technical specialists (Vorisek et al. 3). The fidelity principle involves restricting the combination of values with divergent data types while the implementability principle encompasses creating resources that can easily be interpreted and shared using existing industry standards, approved data sharing techniques, and normal programming languages (HL7; Joao et al. 1254). These principles form the basis of FHIR’s interoperability and efficacy.
The FHIR specification is subdivided into different components. One such module relates to the foundation, which describes the fundamental structure on which the entire specification is developed (HL7). The other element is implementer support, which assists implementers in utilizing the FHIR standard (Ayaz et al. 2). The security and privacy module helps in creating and maintaining the specification’s confidentiality, safety, and integrity (HL7). The conformance component provides the standard’s implementation guideline (HL7). The terminology module offers support to language and associated elements (Boussadi and Zapletal 2). Other modules include administration, medications, linked data, and clinical. Linked data describes various approaches to data sharing for resources while medications encompass tracking of immunization and therapy management (HL7). The administration module entails fundamental resources for monitoring key stakeholders and equipment while the clinical module encompasses essential medical data, including care plans and challenges (Rosa et al. 526; Liu et al.). Additional FHIR specification modules include clinical reasoning, diagnostics, financial, workflow, and medication definition. Diagnostics entails diagnostic requests and reports while the financial component involves claiming and billing-related assistance (HL7). The workflow component encompasses the care management process while clinical reasoning entails quality measures and clinical decision-making assistance (Rosa et al. 528). The medical definition component provides satisfactory descriptions of medications (HL7; Liu et al.). While the FHIR specification is designed to assist a broad range of users, it is principally tailored to the implementers (Shah 3; Vorisek et al. 12). Since FHIR is supported by servers, community-created drive, and internet-accessible specifications, it has been adopted by other healthcare standards firms, including Integrating the Healthcare Enterprise (IHE) (Shah 3; Liu et al.). Thus, the FHIR standard is considered a revolutionary step towards eliminating several healthcare data-sharing challenges.
Importance of FHIR to US Healthcare
The FHIR standard is of great benefit to U.S. healthcare. It offers U.S. healthcare stakeholders, including healthcare providers and patients, exceptional experiences similar to those enjoyed by users of other web-based systems in other sectors (Ayaz et al. 2). Moreover, the FHIR standard contributes to making various healthcare monitoring equipment and wearable devices valuable from a clinical viewpoint (HL7). Additionally, the healthcare IOT (Internet of Things) is rapidly increasing. However, the tools available for linking PGHD (patient-generated healthcare data) to efficient provider workflows are insufficient (Boussadi and Zapletal 2; Liu et al.). As such, FHIR offers a great opportunity for the effective connection of electronic health records (EHR) with numerous PGHD sources, including various RPM (remote patient monitoring) devices, while ensuring easy data accessibility and actionability by providers.
The FHIR standard allows healthcare organizations to effortlessly, efficiently, and securely store, update, recover, and exchange patient information without compromising interoperability between various healthcare systems. As such, FHIR plays a crucial role in ensuring effective patient data management within the digital space (Joao et al. 1250). It acts as the basis for various advancements in healthcare infrastructure, including the development of different AI (artificial intelligence) applications that largely depend on extensive datasets made available by FHIR (Joao et al. 1250). In addition, FHIR has a hierarchical coding system that assists healthcare organizations in ensuring effective data management and upholding organized and secure patient confidentiality (HL7). These benefits collectively enhance patient data interoperability and exchange by streamlining execution without forfeiting data integrity.
The FHIR standard utilizes existing theoretical and practical models to offer a coherent, easily implementable, and vigorous process of sharing information between different healthcare systems. For instance, situation-specific healthcare applications founded on the FHIR standard could perform data analysis on patient users and PGHD by summarizing various patterns deemed pertinent to a specific element of patient well-being or chronic ailment management (Boussadi and Zapletal 3). Moreover, through the use of FHIR, patients who interact with providers in varied healthcare systems would not have to be bothered about having multiple patient portals from providers with dissimilar electronic health records (Boussadi and Zapletal 3; Rosa et al. 530). The FHIR standard allows the integration of patient information from different healthcare organizations, providing a comprehensive understanding of all the relevant data, including medications and challenges, and optimizing care coordination.
The FHIR standard allows healthcare providers to customize their software tools to satisfy their patients’ needs. It enables providers to obtain information from multiple evidence-based resources to enhance clinical decision-making and foster precision medication for optimal patient outcomes (Shah 4). Additionally, FHIR can be combined with the RLS (Record Locator Service) system to enhance healthcare providers’ effortless and effective identification of indispensable FHIR resources, including relevant prescriptions, laboratories, and allergy-related data (Boussadi and Zapletal 10; Rosa et al. 528). These benefits indicate that the FHIR standard has multiple promises and has attracted considerable support beyond the U.S. healthcare system, rendering it a great platform for improving patient engagement and optimizing patient outcomes.
Federal Requirements for FHIR Implementation
The federal government, through the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC), has recognized FHIR as the underpinning standard for supporting the sharing of healthcare data via safe APIs (application programming interfaces). In its final rules, the CMS considered FHIR as the basis for establishing a future in which information would be exchanged freely and safely among patients, healthcare providers, and payers, thereby ensuring optimal care coordination, minimal healthcare costs, and enhanced patient outcomes (ONC 6; Liu et al.). The FHIR APIs are designed to assist the ONC in monitoring and analyzing FHIR standardization endpoints utilized by various healthcare providers (ONC 10). Section 85 FR 170.404(b) (2) of the ONC Cures Act Final Rule obligates FHIR implementers or approved API developers to have a record of their FHIR endpoints as uncovered by the relevant API Information Sources (ONC 17; Boussadi and Zapletal 3). Moreover, the maintained list of FHIR endpoints must be machine-readable and freely or easily accessible (ONC 17). These requirements are designed to guide API developers and ensure effective FHIR implementation.
The federal government, through the ONC, requires certified API developers to utilize the HL7 FHIR 4.0.1 or its profiles, including the “Validated Healthcare Directory Implementation Guide,” to characterize endpoints (service base URLs) that patients can leverage to monitor or manage their medical data. The federal government, through the ONC, requires API developers to give satisfactory details about the service base URLs, including the provider identifiers, locality, and identity of the API Information Source’s organization (ONC 18; Boussadi and Zapletal 9). Additionally, considerable confidentiality glitches persist in federal law guiding the exchange of healthcare information between non-HIPAA-covered innovations and HIPAA-covered establishments (Shah 3; Liu et al.). FHIR-related APIs do not merely enhance the sharing of data between covered entities (Liu et al.). The 21st Century Cures Act Final Rule of the ONC requires EHR developers to execute FHIR-related APIs that allow easy accessibility to third-party mobile apps (Liu et al.; HL7). The same rule has information-blocking provisions that prevent healthcare providers from stopping patient-authorized information disclosure to specific apps via APIs, irrespective of the apps' data handling reputation (Liu et al.). These requirements are designed to optimize FHIR execution and ensure patients’ reliable and easy access to relevant electronic health data.
Conclusion
The FHIR standard utilizes modern conjectural and practical models to create a coherent, easily implementable, and robust process of sharing information among various healthcare applications based on the applicable federal regulations. FHIR is founded on internet standards commonly used by various non-healthcare sectors. The FHIR's fundamental building block is the resource, which describes individual data units or shareable content. While one resource could be utilized independently for a specific use case, resources are mostly pooled and tailored to satisfy the specific needs of the use case. The FHIR specification is subdivided into different components to enhance implementation. While the FHIR specification is designed to assist a broad range of users, it is principally tailored to the implementers. The FHIR standard offers U.S. healthcare stakeholders, including healthcare providers, patients, and clinicians, exceptional experiences similar to those enjoyed by users of other web-based systems in other sectors. The federal government, through the CMS and the ONC, requires FHIR implementers to have a record of the FHIR endpoints. The endpoints must be machine-readable and easily accessible. The FHIR's design is principally founded on the need to allow interoperability through properly organised information models that utilize straightforward and efficient data-sharing processes.
Works Cited
Ayaz, Muhammad, et al. “The Fast Health Interoperability Resources (FHIR) Standard: Systematic Literature Review of Implementations, Applications, Challenges and Opportunities.” JMIR Medical Informatics, vol. 9, no. 7, 30 July 2021, doi:10.2196/21929.
Boussadi, Abdelali, and Eric Zapletal. “A Fast Healthcare Interoperability Resources (FHIR) Layer Implemented over I2B2.” BMC Medical Informatics and Decision Making, vol. 17, no. 1, 14 Aug. 2017, doi:10.1186/s12911-017-0513-6.
Health Level Seven International (HL7). “FHIR Overview.” HL7, 2024, www.hl7.org/fhir/overview.html.
Joao, Pavao, et al. “The Fast Health Interoperability Resources (FHIR) Standard and Homecare, a Scoping Review.” Procedia Computer Science, vol. 219, 2023, pp. 1249–1256, doi:10.1016/j.procs.2023.01.408.
Liu, Tz-Jie, et al. “Building an Electronic Medical Record System Exchanged in FHIR Format and Its Visual Presentation.” Healthcare, vol. 11, no. 17, 28 Aug. 2023, doi:10.3390/healthcare11172410.
The Office of the National Coordinator for Health Information Technology (ONC). “Lighting the Way for FHIR® API Implementation: Solutions for Endpoint Publication and Discovery.” The Office of the National Coordinator for Health Information Technology, 2023, www.healthit.gov/sites/default/files/2023-08/20230808_Lantern-lighting-the-way-FHIR-implementation-report-508.pdf.
Rosa, Marco, et al. “A Fast Healthcare Interoperability Resources (FHIR) Implementation Integrating Complex Security Mechanisms.” Procedia Computer Science, vol. 164, 2019, pp. 524–531, doi:10.1016/j.procs.2019.12.215.
Shah, Wasim. “Exploring the Impact and Evolution of Fast Healthcare Interoperability Resources (FHIR) On Healthcare Systems, Personal Health Records and Data Security.” Journal of Health Education Research & Development, vol. 11, no. 3, 2023, pp. 1–5, doi:10.37421/2380-5439.2023.11.100076.
Vorisek, Carina Nina, et al. “Fast Healthcare Interoperability Resources (FHIR) for Interoperability in Health Research: Systematic Review.” JMIR Medical Informatics, vol. 10, no. 7, 19 July 2022, doi:10.2196/35724.
