FHIR, or Fast Healthcare Interoperability Resources, is one of the next generation HL7® standards in healthcare data integration, and is focused on decreasing interoperability costs, and unlocking technical innovation in healthcare. It is an evolving standard, currently at trial stage. It was created with implementers in mind, and is well supported in the vendor community.
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Why FHIR? In 2011, the board of HL7 noted that interoperability requirements were increasing, there was the need for real time access for APIs, especially with the uptake of mobile use. The vast increase in the amount, type, and source of data particularly with the increasing use of personal devices. There was a movement to include the patient in their own healthcare. Plus, data from genetics, and precision medicine increased the amount of data available to be included in a patient’s electronic health record. With aging populations, and the increase in chronic diseases the ability to data mine analytics, and be proactive with population health management was required. To be able to do this, implementers expected a modern standard as the existing HL7 standards were lacking, and to handle this huge increase of data, a fresh look was needed, and so FHIR was born.
FHIR does three key things:
- It defines a way to represent information to be shared like problems or allergies called resources, and a way to adapt them to a specific usage called profiling.
- It describes how to share those resources – whether as a real-time API for a mobile application, a document or a message between systems. These are same ones that are used by Google, Facebook, and Amazon.
- And, most importantly it encourages a co-operative community of users who all work together to make FHIR the most useable standard yet defined.
This has resulted in lowered cost of entry for new vendors, improved access to data, and an increase in the commercial viability of app development. It encourages the development of an ecosystem of FHIR compliant apps that can work with different FHIR servers.
Who will FHIR benefit? Clinicians, patients, implementers, and healthcare organizations.
What are the benefits for clinicians? FHIR®improves access to a more complete, higher quality electronic health care record, by being able to include data from traditional sources like laboratory results, and to evolving sources like genomic information. FHIR® improves the work flow to organize, and manage investigations. There will be a greater choice of applications, and devices to support clinical workflow. The speed of development will increase, and in turn business problems will be solved faster. The ability to share information seamlessly will result in time saving for clinicians, so they will be able to focus on the patient, and their care.
What are the benefits to patients? The development of applications targeted at patient engagement are increasing, FHIR® removes the technical barriers for data from patient engagement apps to be included in clinical systems. This gives clinicians access to a more complete patient record, and therefore provides improved tools to assist in the decision making process. This can lead to efficiencies in diagnosis, and treatment of patients, and lead to improved quality care.
Overall this helps to improve the patient experience and helps to reduce the waiting time spent within the healthcare system for a patient.
What are the benefits to implementers? Familiar tooling and technologies, such as XML/JSON, HTTP, REST, SSL, OAuth are used. Predefined resources, and APIs which allow implementers to focus on the core application functionality. There is extensive documentation, samples, and reference server implementations available. Plus, an active, and supportive global community is available 24/7, it is possible to get answers to questions within minutes. Open Source code libraries are available like HAPI (Java) and Furore (.Net). These libraries are freely available to anyone. FHIR® is mobile friendly, which is a core competency of any modern technology.
What are the benefits to healthcare organizations, especially hospitals? Most vendors are committed to FHIR®, this is beneficial as it increases the range of applications able to be deployed, which should lead to faster deployments, lower cost interoperability, and reduced vendor lock-in. As FHIR® is adopted by source systems, it is easier to swap out non-performing systems. Many healthcare organizations have teams developing FHIR® applications specifically designed for their organization needs, which can communicate with larger systems. This provides consistent interfaces that can be used immediately within organizations.
What are FHIR’s® current challenges? Mapping from existing data sources to FHIR® can be difficult, there is work involved with getting FHIR® talking to the back end connections. You still need to think about security, and the need to use external standards. Also, alignment between different parts of the sector is complicated, workflows may need to be altered to make use of the FHIR® capabilities. I am sure these challenges will be addressed in the future with the current development that is underway.
What does the future hold? There is enormous interest locally, and internationally about FHIR®. It promises to revolutionize sharing of healthcare information, and now is the time for clinicians, and patients to be more involved, to become a part of the FHIR® phenomenon.
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