- Standardized framework for healthcare data exchange
- Seamless interoperability between health IT systems and applications
- Improved communication within the healthcare industry
- Enhanced patient care and outcomes
The rapid evolution of the healthcare industry has led to increasing demand for seamless and interoperable exchange of health information. Fast Healthcare Interoperability Resources (FHIR, pronounced “fire”) has emerged as a widely adopted standard that streamlines data exchange and enhances healthcare workflows. Developed by Health Level Seven International (HL7), FHIR provides a common structure, format, and vocabulary for health information, enabling easy sharing and understanding across different health IT systems. In this article, we will explore the key components and resources of FHIR that are transforming healthcare data exchange.
Differentiating features of FHIR compared to other health interoperability standards
It is challenging to efficiently coordinate care, make decisions, or analyze data because most HIE today is document-based. Although standards like C-CDA contain a wealth of useful information, extracting that data and making it usable in other forms requires more effort. The completion of document-based information transmission also limits providers’ ability to dig further into received data. Because the user doesn’t have access to the patient’s full medical record, it’s not enough to just send over lab results and an allergy list.
However, there is currently no technology that can connect the vast amounts of patient-generated health data (PGHD) that is being generated by millions of FitBits, Bluetooth scales, Apple Watches, blood glucose monitors, diet apps, and fitness trackers that are being integrated into provider workflows. If providers can’t quickly and easily tap into this pool of PGHD, it serves no purpose. Access to this PGHD, that might otherwise be “locked” by FHIR on an FHIR platform, will allow users to perform a variety of downstream operations, such as data analytics and displaying trends crucial to, say, chronic disease management or patient wellness.
The FHIR protocol is currently widely used in healthcare for server connections, cloud communications, transferring data amongst electronic health records, and mobile apps.
FHIR is built around several key components and resources:
- Resources: Resources are the core building blocks of FHIR. They represent granular healthcare data elements, such as patients, providers, medications, or diagnostic reports. Each resource has a defined structure, properties (called elements), and relationships with other resources.
Some common FHIR resources include:
- Patient: Represents a person receiving healthcare services.
- Practitioner: Represents a healthcare provider, such as a doctor, nurse, or pharmacist.
- Encounter: Represents an interaction between a patient and a provider for the purpose of providing healthcare services.
- Observation: Represents a single piece of clinical information, such as a lab result or vital sign measurement.
- Medication: Represents a prescribed or administered medication.
- Condition: Represents a medical condition, disease, or diagnosis.
- Data Types: Data types define the structure and format of the elements within resources. FHIR provides a set of predefined data types, such as strings, numbers, dates, and more complex types like Address or HumanName.
- Extension: Extensions allow for the addition of custom elements to resources without altering the base resource definition. This provides flexibility to tailor FHIR resources to meet specific use cases and requirements.
- Profiles: Profiles are derived from resources or data types and provide constraints, such as required elements or value sets, to ensure data consistency and interoperability. Organizations can create profiles to implement specific workflows, enforce business rules, or comply with regional regulations.
- Operations: Operations are predefined actions that can be performed on or with resources, such as creating, reading, updating, or deleting (CRUD) resources. FHIR also supports search and other custom operations.
- RESTful API: FHIR uses a Representational State Transfer (REST) architecture to provide a standardized API for exchanging resources. The API supports basic CRUD operations, search, and other interactions with resources using common web protocols like HTTP and JSON or XML for data exchange.
- Interactions: FHIR supports various interactions between resources, such as referencing, bundling, and transactions. Referencing allows resources to be linked, bundling groups multiple resources into a single message, and transactions enable multiple resource operations to be processed atomically.
- Terminologies: FHIR incorporates standard terminologies, such as ICD-10, SNOMED CT, and LOINC, to facilitate semantic interoperability and consistent representation of clinical concepts. Terminology bindings are used to map resource elements to specific terminologies and value sets.
Resources, references, and profiles are all parts of FHIR.
FHIR’s main goal is to supply a fundamental collection of data items called resources, which, when coupled via references, should address the vast majority of clinical use cases. More health-related scenarios can be accommodated through the profiling extension technique. FHIR growth focuses on three main areas: resources, references, and profiles. Let’s examine them one by one.
The foundation of FHIR solutions is made up of resources. Resources are data exchange or storage packets that accommodate the vast majority of clinical use-cases.
Take a source as an example. The administrative and demographic details of a cared-for person or animal are referred to as “patient” here. Scheduling, patient administration, medical billing, and information tracking are just few of the areas that a plethora of resources address in the healthcare business.
Resources come in a wide variety of representations and define the type and format of information that will be transmitted over them (UML, XML, JSON). Explanations may be included in plain text format as well.
Resources are rarely used independently, and the vast majority of them include references to other materials. Linking Patient to Observation (which stores remarks made about a patient), medication, and condition (problem or diagnosis), allows you to implement and customize certain situations (amount, ingredients and strength of medications). Textual descriptions, specific identifiers, and Web address (URL) citations are all acceptable forms of reference.
A resource’s profile defines how that resource will be used in a certain context. Developers document the changes they’ve made to FHIR-based APIs and how they can be used in Implementation Guides.
In this particular case. The Blue Button FHIR API was developed by the Centers for Medicare & Medicaid Services to facilitate data exchange between healthcare providers and Medicare beneficiaries. Its Implementation Guide (IG) features profiles for a wide variety of use cases, such as “Coverage Profile,” “Carrier Claim Profile,” “Inpatient Profile,” and so on. If you click on a profile name, you may read about the requirements and benefits associated with that profile.
This stated approach is required for interoperability compliance but can be technically challenging; fortunately, there are templates and resources available for creating an implementation guide. There are as many seminars and classes tailored specifically to IG developers as there are to FHIR implementers.
Profiling is a challenging part of FHIR adoption because it calls for expertise in both the whole range of FHIR resources and the specifics of their technical implementation. As a result, an application was created with in-built profiles to facilitate communication between systems. Let’s talk about SMART on FHIR and the potential benefits of implementing it.
SMART on FHIR
To begin fixing the interoperability problem, a standard known as SMART (Substitutable Medical Applications, Reusable Technology) was developed. Even yet, FHIR was the pioneer to gain support from the healthcare sector. As a result, SMART shifted its focus to bolstering FHIR implementations, doing so primarily through the creation of resources and guidelines for app developers working with the FHIR framework.
There are now two offerings from the SMART on FHIR project:
Foundation for developing applications that adhere to the FHIR standard, including software libraries, documentation, sandbox environments, and more; platform for publishing and using FHIR apps.
The primary objective of SMART is to provide a market where healthcare providers and their patients may freely choose and switch between electronic health record (EHR) apps that best suit their needs. For this to work, however, apps will need robust security and interoperability, which FHIR does not provide.
As a result, SMART on FHIR has two advantages.
It gives docs, hospital CTOs, and patients an easy and low-cost way to connect with hundreds of products on a marketplace. The ability to update apps rapidly should encourage creativity and lead to the growth of a market that can compete with, say, banking or travel apps.
It gives programmers a toolkit of open, clear specifications and profiles for representing various sorts of data, like medications, allergies, prescriptions, and medical conditions. By automating the process of deciding how to represent data, SMART significantly lessens the burden on developers (often based on standard codes like SNOMED).
SMART on FHIR also features an authorisation and authentication mechanism. It uses OAuth to let third-party apps access EHR data. OpenID Connect technology also ensures safe login for these apps.
FHIR components and resources have revolutionized the way healthcare data is exchanged, enabling seamless interoperability between various health IT systems and applications. With its modular, extensible design, FHIR provides a robust framework for healthcare organizations to improve data exchange and interoperability, ultimately enhancing patient care and outcomes
For your healthcare businesses, Arkenea provides EHR/EMR software that is interoperable. It was developed with the goal of integrating easily with the practise management systems that your facility utilises. Contact Arkenea if you want to learn more.