FHIR could help health systems achieve interoperability.
My company, Health Samurai, has been working with the Fast Healthcare Interoperability Resources (FHIR) standard for the last six years. By now, it’s clear to me that FHIR will shape the future of healthcare IT. The problem is, most healthcare technology professionals tend to overlook some key FHIR facts.
You won’t be able to use FHIR to benefit patients unless you truly understand it.
Here’s what everyone in health tech must know about FHIR and its potential to advance interoperability.
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FHIR is a specification for healthcare data exchange developed by Health Level Seven (HL7), the same organization that developed the ubiquitous HL7 v2 messaging standard. FHIR was built with modern web technologies that are already being used in other industries, and it’s focused on simplifying system integrations with well-defined data models and application programming interfaces (APIs) to improve interoperability.
Historically, long health IT development cycles, high costs and domain complexity limited innovation in the industry. FHIR has the potential to change the status quo and accelerate innovation by breaking down data silos, lowering development costs and cutting development time to enable an ecosystem of modern, connected healthcare solutions.
FHIR is so much more. It is a community of highly active health information technology experts who have gotten together to solve complex health technology problems. Anybody can join this community — they just register at chat.fhir.org, and within minutes they can start communicating with the leaders of the FHIR community such as Grahame Grieve, Lloyd McKenzie and Josh Mandel. There are also offline events that provide a chance to engage with the community. HL7 (Health Level 7) organizes three FHIR connectathons every year, right before the general group meetings.
The first part of the specification describes how to represent clinical and financial information as FHIR resources. The second part describes paradigms of data exchange, such as how one system can query data from another system through the REST API, how two systems can exchange data via messaging, and how to combine multiple FHIR resources into documents.
FHIR is supported by many stakeholders in the industry. The governments of the United States, Canada, Australia, Europe and other countries are working on FHIR projects. Major electronic health record (EHR) vendors such as Epic and Cerner have already implemented FHIR APIs and opened their FHIR application stores. In the pharmaceutical industry, there is a consortium of companies called Transcelerate that has participated in every FHIR connectathon in the last two years. Medical insurance companies have started a project called Da Vinci to accelerate FHIR adoption. The project has brought together a significant number of medical insurance companies, and they are working on FHIR use cases for the medical insurance industry. Large hospital systems have started developing SMART on FHIR applications to supplement their EHR systems with additional functionality.
FHIR is available to anyone, at any moment, without any fees. This is important, but aside from the availability of the specification, the fact that FHIR is open source sets up a very good trend toward producing open-source solutions around FHIR. The FHIR community has already developed many open-source tools and libraries that engineers from different companies can benefit from. It doesn't matter what kind of technology you’re using — you will find components that support your development.
It’s pretty obvious to anyone if you think about integration with other solutions that support HL7 FHIR. However, in any given health system, there exists many legacy interoperability standards. You will find many HL7 v2 implementations and see many CCD documents. Thankfully, FHIR makes integrations with legacy system easier even then because FHIR has a well-documented mapping between FHIR and legacy interoperability standards. Also, the FHIR community has produced many tools and libraries that support data translation from HL7 v2 to FHIR, from CCD to FHIR, etc. So integrations are much easier with FHIR, even if FHIR isn’t implemented in all systems yet.
FHIR introduces application stores and microservices architecture. Look at the legacy systems implemented in the current healthcare organization, and it’s clear that most of them are large monolithic systems that try to serve every function, to every user. As a result, these systems take a very long time to implement and update. FHIR enables an ecosystem of connected healthcare applications developed by different vendors. Soon organizations will be able to choose the best components developed by different companies and bring them together into an ecosystem of connected healthcare applications. These organizations will be able to replace solutions developed by one company with solutions developed by another company without spending a significant amount of time and money on integrations.
The most overlooked fact about FHIR is actually my favorite feature of FHIR. All the health technology experts understand well that FHIR can be used for accessing data inside some legacy systems through the FHIR API, but there is another amazing use case for FHIR. It is also great for storage and analytics and can be used as a backend data model for building new healthcare solutions. At Health Samurai, we recognized this use case several years ago and nowadays, our main product is the FHIR backend, which we use for the development of solutions for our clients.
Here are some lessons learned: When using a FHIR backend, value creation comes faster because organizations don't have to spend that much time on the backend. FHIR solutions are future proof, and they’re interoperable. Also, onboarding new engineers is much easier. There’s no need to explain to them data structures; instead, just refer them to the FHIR specification.
Pavel Smirnov is CEO of Health Samurai, and he can be reached here. To learn more, check out Health Samurai’s FHIRbase Dojo, a blog dedicated to teaching the community about using FHIR for storage and analytics.
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