Fundamentals of FHIR and its role in HEDIS webinar summary

As part of NCQA’s Digital Quality Expert webinar series, Firely joined the conversation to explore the fundamentals of FHIR (Fast Healthcare Interoperability Resources) and its growing role in HEDIS digital quality measures (dQMs) and Health Equity Advancement strategies (HEAs).

Featuring insights from Firely’s senior leadership team—Michelle Beck (SVP of Growth), Mat Osmanski (Principal Consultant), and Rich Almeida (VP of Product Strategy and Compliance)—alongside Steven Miracle, NCQA’s Director of Implementation Success, the session provided a practical introduction to FHIR and strategic takeaways for stakeholders to streamline quality reporting and advance data-driven healthcare.

Read on for a breakdown of the webinar highlights below. You can also watch the complete webinar recording here.

What is FHIR? 

HL7 FHIR is a modern standard for structuring and exchanging healthcare data. In his introduction, Mat Osmanski focused on three core components that make it both powerful and flexible: 

Resources 

At the core of FHIR are modular building blocks called resources. These represent various healthcare concepts such as: 

• Administrative: Patient, Practitioner, Location 
• Clinical: Condition, Procedure, AllergyIntolerance, Medication 
• Financial: Claim, Coverage, ExplanationOfBenefit 

These resources define how data is structured and exchanged in a standardized, machine-readable way—crucial for interoperability between health systems, apps, and data platforms. 

Profiles 

Profiles apply constraints to resources, tailoring them for specific use cases or regulatory requirements. For example, the US Core Patient Profile tightens the base definition of the Patient resource to meet U.S. interoperability guidelines. Profiles can also be layered to support both general standards and local variations. 

Terminology 

FHIR’s use of consistent code systems—such as SNOMED CT, LOINC, and ICD-10—ensures semantic interoperability. This means different systems can share and interpret data reliably, which is essential for accurate clinical decision support, analytics, and quality reporting.

How FHIR supports HEDIS  

As the healthcare industry transitions toward digital measurement, FHIR plays a central role in enabling scalable, accurate, and automated quality reporting. The webinar explored how FHIR addresses several long-standing challenges in HEDIS measurement: 

• Standardized Data Sharing: FHIR provides a consistent framework for data exchange, allowing payers, providers, and vendors to align on how data is formatted and transmitted across diverse systems—improving accuracy and comparability of HEDIS measures. 

• Improved Reporting Efficiency: FHIR reduces the need for manual chart reviews and legacy data extraction processes, enabling more efficient, automated workflows for NCQA customers and other stakeholders. 

• Enhanced Data Quality: Structured, high fidelity data made possible through FHIR resources and profiles ensures that the data used in digital measures is more complete, reliable, and suitable for real-time analysis. 

• Interoperability for Analytics: FHIR enables integration of clinical and administrative data, allowing business intelligence and quality teams to uncover actionable insights and track performance more effectively.

Mapping HEDIS concepts to FHIR terms 

A critical portion of the webinar walked attendees through the “anatomy of a measure” using FHIR. The speakers identified common FHIR resources used across nearly all digital measures and showed how Clinical Quality Language (CQL) interacts with the FHIR measure library. 

These core resources include:

1. Patient
2. Encounter
3. Observation 
4. Procedure 
5. Claim 
6. ExplanationOfBenefit 
7. Coverage 
8. MeasureReport 

By understanding these building blocks, teams can begin aligning their internal data models with the structure required for FHIR-native digital measures.

Practical advice: Starting your FHIR + HEDIS journey 

In the final segment, the panel addressed questions from the audience, offering tangible tips for teams at various stages of digital quality adoption, including: 

What advice would you give to a team starting its FHIR + HEDIS journey? 
Begin with a focused pilot, invest in foundational training, and build incrementally with a clear understanding of data readiness. 

What does a realistic dQM proof-of-concept look like? 
A successful POC focuses on 1–2 measures, validates key workflows, and involves tight collaboration across clinical, data, and quality teams. 

What’s happening with market adoption of dQMs? 
There is growing momentum, with many organizations transitioning from pilot phases to scalable implementations as infrastructure matures.

The takeaway: Future-ready quality measurement 

The shift to FHIR-based HEDIS measures is more than a technical upgrade—it’s a strategic opportunity to modernize data infrastructure, reduce administrative burden, and deliver better insights into care quality and equity. 

By embracing FHIR, organizations can not only meet regulatory expectations, but also build the foundations for more intelligent, patient-centered, and interoperable healthcare systems. 

For those just getting started, the message was clear: start now, start focused, and build forward. The future of digital quality measurement is here—and it’s built on FHIR.

Want to dive deeper? Watch the full webinar recording here.