FHIR (Fast Healthcare Interoperability Resources)

Why FHIR is important

As health IT and electronic health records (EHRs) continued to be plagued by interoperability problems, FHIR emerged in 2014 as a draft standard for trial use to enable health IT developers to more quickly and easily build applications for EHRs and to exchange and retrieve data faster from applications.

While FHIR at first was a somewhat experimental project for HL7, it quickly acquired support from even fiercely competitive EHR vendors such as Epic Systems Corp., Cerner Corp. and AthenaHealth Inc. An HL7-backed consortium -- the Argonaut Project -- that includes the two EHR giants and other major health IT vendors, sprung up and moved FHIR forward to the point at which, in February 2017, it became a full standard, though still for trial use. HL7 is expected to soon grant FHIR full standard status.

Another significant FHIR effort, SMART on FHIR, is based at Boston Children's Hospital, and has also gained broad industry support. SMART on FHIR is a set of open specifications to integrate apps with EHRs, portals, health information exchanges and other health IT systems, according to the organization. Another is HAPI FHIR, a new library for adding FHIR messaging to applications. It was developed at University Health Network in Ontario, Canada. HAPI FHIR is open source and free to use.

How FHIR works and what's a FHIR resource

FHIR frameworks are built around the concept of resources -- basic units of interoperability and modular components that can be assembled into working systems to try to resolve clinical, administrative and infrastructural problems in healthcare. FHIR provides software development resources and tools for administrative concepts such as patients, providers, organizations and devices, as well as a variety of clinical concepts including problems, medications, diagnostics, care plans and financial issues, among others.

Unlike HL7's most widely used formal standard (also called HL7), FHIR is designed specifically for the web and provides resources and foundations based on XML, JSON, HTTP, AToM and OAuth structures. Tools can be reused to improve interoperability to retrieve the history of a specific resource or a specific version. The specification is online, fully hyperlinked and can be linked from the resource of a property to the data type of that property. FHIR can be used in mobile phone applications, cloud communications, EHR-based data sharing and among institutional healthcare providers.

The FHIR specification is broken into three parts: general documentation, implementation and resource list. General documentation describes how resources are defined and gives background material including definitions of data types, codes and XML and JSON formats. Users can use resources with the RESTful architecture programming interface as clinical documents or in a service-based architecture.

FHIR defines a framework for extending and adapting resources, which can be read by any system, regardless of the way they were developed. Extension definitions can be retrieved using the same framework as retrieving other resources. Each resource carries human-readable text representation using HTML.

The HL7 organization

HL7 is an international organization with members in more than 50 countries. Leaders of the organization have complained that some bigger members, including vendors and healthcare providers, have failed to adequately support HL7's standards development work, particularly in regard to FHIR. That lack of funding has slowed the progress of FHIR, HL7 CEO Charles Jaffe, M.D., has alleged. Nevertheless, Jaffe and other HL7 leaders point out that FHIR is already being widely used by vendors and healthcare organizations to build and run health IT applications.

HL7 develops new standards using a multiyear balloting system in which members vote and add commentary in successive balloting rounds until negative comments are eliminated, draft standards, draft standards for trial use and formal standards are commonly agreed upon.