healthtech 

Unlocking Healthcare Interoperability with Fast Healthcare Interoperability Resources (FHIR)

The healthcare industry is undergoing a significant digital transformation, revolutionizing how technology is employed to enhance patient care. Among the key changes is the complete digitization of health records and the push for cross-platform interoperability. This shift not only improves workflows and capabilities but also prioritizes patient privacy. Governments worldwide are also revising regulations to encourage the healthcare sector to embrace these transformative measures.

In the past, patient records and health data were documented on paper and stored in file folders at medical offices. The introduction of fax machines facilitated data sharing between organizations to some extent. Subsequently, initiatives like the Health Insurance Portability and Accountability Act (HIPAA) were introduced, but these often fell short due to varying regulations and standards.

With the development of Electronic Health Record (EHR) systems, secure digital transfer and portability of patient records between systems became possible. However, even with these advancements, many challenges persisted, particularly in data formatting and availability. Different system developers offered diverse methods of data sharing, or sometimes even hindered it.

To address these issues, Health Level Seven International (HL7), established as a non-profit ANSI-accredited standards developing organization in 1987, played a pivotal role in promoting data portability within the industry. HL7 became a leader in defining standards for data sharing and interoperability, offering a range of common data portability formats. Over the years, these formats have evolved to meet the needs of data providers and consumers, with varying degrees of success.

Initial formats such as HL7 version 2 and version 3 provided a solid foundation for data interoperability. However, these versions were either too unstructured or too limited in scope to be universally applicable across clinical applications. Consequently, many vendors developed their own data formats and Application Programming Interface (API) standards for data sharing. This lack of a mandated standard for data exchange resulted in fragmented integration and significant challenges for vendor integration teams. Each EHR system had its own data formats, often utilizing industry standards alongside custom formats, which necessitated custom implementations for each platform being integrated. This required substantial time and financial investments, turning the very APIs designed for data portability into major hurdles for broader integration strategies.

Introducing Fast Healthcare Interoperability Resources (FHIR), the latest standard introduced by HL7. According to HL7, the FHIR data model aims to simplify implementation and improve data sharing and interoperability while maintaining information integrity. FHIR leverages existing logical and theoretical models to offer an easily implementable, consistent, and robust mechanism for exchanging data between healthcare applications. Embracing this data model can bring about radical changes in how medical institutions collect and share data.

The FHIR data model establishes a standard for structuring resources and associated metadata, such as EHR capabilities and clinical content, in a consistent, modular format that remains flexible. Although designed for computer systems, FHIR data is structured in a way that allows for human readability. Understanding the FHIR definition and staying up to date with the current FHIR standard, such as the recently released FHIR HL7 version 4, is crucial. Version 4 represents the first normative release of the FHIR standard, a significant milestone for FHIR HL7 and the future of clinical interoperability in healthcare. This ensures that any future changes to the specification must be backward compatible with version 4, providing vendors with confidence that their implementations will remain viable over time and eliminating the need for extensive rewrites with each new FHIR format release.

The Boston Children’s Hospital Computational Health Informatics Program is actively working on the SMART program, which utilizes the FHIR standard healthcare data structure to establish a global API standard called SMART on FHIR. This new standard offers options for standardizing and streamlining complex integrations into EHR platforms. One notable advantage of SMART on FHIR is the ability to embed applications for existing EHR platforms within the EHR itself. Third-party vendors can develop applications and seamlessly integrate them into the EHR, granting the applications standardized access to data within the system. This extends the capabilities of EHRs without requiring EHR vendors to implement the functionality themselves.

As more organizations, vendors, and healthcare platforms adopt and implement the HL7 FHIR standard, significant advancements can be expected in capabilities for both patients and healthcare institutions.

Moreover, software engineers stand to benefit from implementing the FHIR standard in several ways:

• The FHIR standard is entirely free to use without any restrictions.
• Major vendors, including Apple, Microsoft, Cerner, Epic, and other EHR vendors, provide support for FHIR.
• Numerous free online downloadable tools, such as reference servers and implementation libraries, are available.
• Interoperability is supported out of the box, with default base resources that can be used as-is or modified based on local requirements.
• FHIR supports popular web standards like XML, JSON, HTTP, and OAuth. • The online specifications are concise and easy to understand.
• The human-readable serialization format of FHIR makes it developer-friendly.
• A global community is available to assist implementers.
• By embracing the FHIR standard, healthcare professionals can unlock a wealth of benefits, and software engineers can leverage a robust framework to drive innovation and interoperability in the healthcare sector.