Achieving your FHIR share of interoperability

March 30, 2017

The emerging use of the FHIR Stand­ard unlocks the holy grail of interoperability; it breaks down information silos, enabling appropriate sharing of high-quality healthcare data and images amongst the patient’s multi- disciplinary care team wherever they may be.

By Chris Hobson,Chief Medical Officer and Chief Privacy Officer, Orion Health

The name itself, which stands for “Fast Healthcare Interoperability Resources,” may sound complex. However, this next-generation HL7 standard in healthcare data integration is designed to simplify interoperability. FHIR offers significant benefits not only for health information management professionals, but also for real clinicians and healthcare consumers as they work to improve the quality of care they deliver and experience on a daily basis.

FHIR represents a major standards upgrade in terms of ease of deployment and comprehensive coverage of healthcare domains, thereby boosting health information sharing; additionally, it enables ambitious plans for an app store purpose–built for healthcare use. It speeds application development, improves interoperability, and enables new possibilities such as mobile access to shared data.

Several trends are driving accelerated adoption of the FHIR standards. There is significant demand for real-time access to data via application programming interfaces (APIs), especially with the increase in the amount, type, and sources of data. Additionally, the consumerization of healthcare, as patients take on more responsibility for their care, demands that we enable patients’ access to their personal data.

There is growing potential to include genomic and precision medicine data in a patient’s electronic health record (EHR). And with the aging population and an increase in chronic diseases, analytics offer a much more proactive approach to population health management—a top priority for all health systems. In turn, the quality of the analytics reports depends on the availability of high quality comprehensive data. This is something that FHIR enables better than any of our previous technologies.

Resources–the basic units of interoperability, data exchange

As it continues to grow in use, FHIR will help resolve the challenge of providing real-time access to data for clinical use. In the longer term, FHIR will help support access to vital, even life-saving, data just by pushing a button on a mobile app.

So, what exactly is FHIR? This stand­ard is built on basic units of interoperability, which in the language of FHIR are named “resources.” A resource is the smallest amount of information that can be exchanged in any one message and could be clinical—such as a problem, medication, or allergy; or administrative—such as an encounter, appointment, practitioner, or claim.

By itself, a single resource possesses limited value. To exchange more meaningful information, FHIR joins individual resources together into more familiar formats such as:

  • clinical documents including discharge summaries, referral letters, or progress notes;
  • messages sent between systems to update information; and
  • real-time APIs that enable new applications such as an app on a mobile device.

FHIR provides real-time, high-quality, shareable information that is available for both immediate viewing by clinicians and other purposes such as clinical decision support or population-based analytics. For example, a prescribing service may apply decision support logic such as drug interaction and allergy checking to the integrated data from a FHIR interface.

FHIR enables significantly better interoperability than previous standards and models. Now, all the paradigms mentioned above can use exactly the same resources internally. For instance, FHIR creates a straightforward approach to assemble a discharge summary (document) with data collected from a clinician (API) and a laboratory (message)–assisted by a context-aware application that assembles the document.

The logical model

It is important to appreciate that FHIR is an ideal tool for discussions and decision making about health information technology solutions by clinicians and health IT professionals. For best results, FHIR anticipates clinicians becoming much more integrally involved in the delivery of health IT projects, and as we know well, clinician-led IT projects have a much higher success rate than technically led projects.

The FHIR approach is to use a “logical model” which has sufficient detail and clarity that both clinicians and IT experts can reach understanding and agreement on the details of the information that is to be shared.

Clinicians provide critical insights in several areas:

  • the basic “resource” information units;
  • references between resources that tell the clinical stories;
  • properties and data types that are the internal parts of the resource;
  • profiling that makes FHIR work within different clinical contexts; and
  • The Value Set—descriptions of the set of concepts for a coded property within the specific context of use.

With the help of the clinical community, expert users can develop a Logical Model unconstrained by the structure of the resource types and profiles that will eventually represent that information—not to mention make it understandable by any system that also understands the FHIR approach.

Once the logical model is completed, FHIR specialists can use it to build profiles and other artifacts needed for effective interoperability. A range of open source tools, such as clinFIHR (, are also available to educate and assist developers and clinicians in the development of the FHIR stand­ard.

The FHIR revolution

FHIR represents a giant leap forward in healthcare integration for the health information professional, the clinician, and the consumer. It will create a more complete, higher quality EHR that will include data from traditional sources such as laboratory results, as well as from evolving sources such as genomic data—and make that information available through any device anytime, anywhere.

FHIR’s focus on simplicity, extensibility, and interoperability promises to revolutionize the sharing of healthcare information and improve the experience and outcomes across the healthcare continuum.

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