Health Interoperability
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Fighting COVID-19 with FHIR (Fast Healthcare Interoperability Resources)

Ward Weistra

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How rapid and efficient exchange of health information can help healthcare workers address the global pandemic

Since its introduction in 2014, many health institutions have taken their time to adopt Fast Healthcare Interoperability Resources (FHIR) into their way of work. As the world battles COVID-19, the inherent value of FHIR is put in the spotlight. To manage the global pandemic, patient data must be captured, stored, and exchanged at every stage of the pandemic. Thanks to FHIR, an international standard for exchanging health data, health IT providers can build solutions to do just that. Let’s take a look at how different countries are now harnessing FHIR to deliver valuable solutions for healthcare communities.

Note: This is not a definitive list. There are more COVID-19-related projects by the FHIR community. Some of the apps mentioned are still in development while others have been released as MVPs.

Tracking the spread of the virus in Italy

Italy is one of the hardest-hit countries in Europe, with the virus spreading faster than it did in China, the origin of the outbreak. Dedalus, a leading health IT provider founded in Italy, has built a full solution for tracking the spread of the virus, including:

  • A phone-based self-assessment flow for patients that serves as a filter for healthcare operators to know which patients to prioritize for follow-up (see video below);
  • Management of clinical assessments and subsequent exams, as well as tracking clinical outcomes;
  • Tracking the subsequent telemedicine process for home-quarantined subjects;
  • A web app for patients to self-monitor and report on clinical parameters (as an alternative for telemedicine).
Video explaining the phone-based self-assessment flow for patients

The table below demonstrates which FHIR resources they used to support each stage of the pandemic process:

Dedalus COVID-19 Solution FHIR Specification

Together with their international partners, Dedalus is offering this system to several countries and local organizations. This solution can be set up anywhere in the world and will first be rolled out in Italy and France.

The FHIR profiles they used to store and exchange data are also shared publicly so that more companies can replicate the initiative. You can find the COVID-19 FHIR profiles on Simplifier. Dedalus built the FHIR profiles with Forge and Firely Terminal (formerly Torinox).

Helping GP’s keep high-risk patients out of the waiting room in Australia

As government officials in Australia begin to release regulations against the novel coronavirus, their General Practitioners (GP’s) are already facing two pressing challenges:

  • Keeping patients out of the waiting room to decrease infection risk
  • Streamlining workflows for telehealth consultations

A group of digital health experts, all part of the FHIR standard development community, have joined forces to address these. The team includes Graham Grieve (sometimes known as the ‘Father of FHIR’), Brett Esler, Brian Postlethwaite, Shovan Roy, and Firely’s very own Vadim Peretokin. Together they created ClinicArrivals, a free, open-source app that combines SMS and online video with the GP’s existing Practice Management System (PMS).

With ClinicArrivals, whenever a high-risk patient books a face-to-face consultation, they receive an SMS instructing them to notify the GP upon arrival and to wait in their car. The GP can then send them a message telling them to either proceed to the waiting room or to wait in the car until a doctor or nurse comes to them. The app also supports teleconsultations as an alternative to live visits –with no installation required for both parties. This saves doctors from switching between apps like WhatsApp or Skype, which interrupts and slows down their workflow.

This integration with the GP’s PMS wouldn’t be possible without FHIR. The ClinicArrivals application is now available for testing in limited production settings and is already being trialed with real patients. It is also available on GitHub for anyone that may want to implement it.

Tracking and enabling self-assessment in Canada

Meanwhile, in Canada, SmileCDR has released the first version of the COVID-19 Self Assessment Tool. The tool collects information about patients’ health and symptoms based on guidelines from public health officials. The system works for both healthcare professionals and members of the public, enabling each to report information electronically. Public health officials can use this information to track the spread of the disease, interact with the population and give help where it is needed. It can be used to create reports based on information received from participants, as allowed by policy.

The tool will be further developed in collaboration with the FHIR Business Alliance and is currently looking for contributors. The open-source file is available here.

The Situational Awareness for Novel Epidemic Response (SANER) project in the US

The US has recently recorded the most number of coronavirus cases globally, quickly overtaking China and Italy. Audacious Inquiry, a health IT and policy company headquartered in Baltimore, has published a draft implementation guide for SANER. The project’s goal is to enable ‘the transmission of high-level situational awareness information from inpatient facilities to centralized data repositories to support the treatment of novel influenza-like illness’. They hope the first draft will inspire the health IT community to collaborate on the rapid development of interfaces and resources to support public health.

Update: Another US-based company, Logica, is managing the COVID-19 Interoperability Project. They are currently coordinating the release of open-source COVID-19 and SARS-CoV-2-related clinical information models, value sets, and interoperability resources. These assets help health systems and HIT implementors worldwide to respond to the pandemic. Among these assets are open FHIR R4 profiles.

Generating synthetic COVID-19 patient data for testing

Another initiative worth mentioning belongs to Synthea. Synthea is an open-source, software mechanism for generating realistic (but not real) patient records at scale. They are now generating synthetic COVID-19 patient data to use for testing new healthcare apps and technologies. This enables software developers to test coronavirus-related software more accurately, without having to gather real patient data. This initiative also allows policymakers to simulate the effects of healthcare policies on the population. You can access the open-source file here.

Nationwide reporting of COVID-19 infections and symptoms in Germany

HL7 Germany’s FHIR working group came together to develop nationwide FHIR profiles for reporting COVID-19 infections. This work focuses on reporting patient symptoms and related pathogen details.

This working group was a completely voluntary effort from public and private institutions, including Firely’s FHIR consultant Alexander Zautke.
The work builds on German national FHIR profiles which HL7 Germany continues to develop on

Complementary to this project, the Robert-Koch-Institute, a German federal government agency responsible for disease control and prevention, followed the example of HL7 Germany and published a set of FHIR profiles
for reporting COVID-19 laboratory results

How can you get involved?

For software developers hoping to contribute, why not join a COVID-19 hackathon? Here’s a list of hackathons you can join to help healthcare systems manage the outbreak. For other members of the IT community, you can join the conversation on Health Level Seven (HL7)’s community via the COVID-19 Response Stream. HL7 has also created a Confluence space dedicated to anything coronavirus-related. The two channels go hand-in-hand for collating projects that address the current pandemic.

All in all, HL7 FHIR’s vision of interoperable healthcare systems is highly relevant to the crisis at hand. As the world battles the COVID-19 pandemic, FHIR has allowed the creation of priceless systems, apps, and solutions to aid patients and healthcare workers in their time of need.

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