Illustration of What is FHIR
Health Interoperability
13 Min Read

FHIR is transforming interoperability in healthcare – but what exactly is it?

Ward Weistra

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We explain the basics

Fast Healthcare Interoperability Resources (FHIR) has revolutionized the digital infrastructure that supports patient care. 

This new health IT data standard fixes the problem of data exchange between disparate systems, and is already widely used for health apps and data-sharing for electronic health records (EHRs).

Why do we need interoperability?

Having access to relevant healthcare data, irrespective of where that data is being stored, has enormous benefits for patients, doctors, healthcare providers and funders, governments, and society at large. 

But there’s a problem, and it’s a tough one. Extensive healthcare IT systems have grown up all over the world, without the ability to seamlessly exchange data. Crucial patient information is locked up in ‘data silos’, and legacy systems still use emails and faxes to transmit records, files, and results. Clinicians treat patients without access to a full history, and researchers can’t get their hands on the de-identified information they need.

FHIR, as a modern interoperability framework, has won the backing of governments, healthcare providers, software vendors, and a fast-growing online implementation community.

How does FHIR facilitate interoperability?

A patient who visits their doctor often needs to provide information about their health. Yet they’ve probably completed the same form many times before. Or they may present as an emergency, too ill to answer vital questions about their existing conditions or allergies. 

By ensuring that different computer systems in different locations can ‘talk’ to each other, FHIR helps to make clinical and administrative information available securely where it’s needed. It uses the same technologies that power the internet, which makes it fast, easy to use, and well-accepted by the developer community. 

Just as internet users anywhere in the world can access the same URL, FHIR apps – given the right permissions – can communicate directly with FHIR-enabled servers. 

Documents and data: what makes FHIR different?

‘Health information exchange’ used to mean sending documents by email or fax. Clinicians and hospitals received lab results without a patient history, or information that had to be rekeyed before the EHR system could use it.

The healthcare IT industry has created a number of interoperability standards in the past to alleviate this problem, standards which are limited in scope, and which have a steep learning curve.  

FHIR allows developers to create apps that transcend legacy regimes and feed information directly into EHR systems and clinical workflows, using technologies they are already familiar with. 

When systems support FHIR, doctors can see their patient’s full medical record in context, instead of isolated documents or messages. Medical devices from different manufacturers can send data to EHRs in clinics and hospitals, and information that used to reside in data silos can now be shared. Data modules or ‘resources’ are quickly combined into clinical and administrative applications, saving time and money.

Where did FHIR come from?

The global healthcare sector needs faster, easier, and better methods to exchange the vast amount of data being generated. The growth of the app economy has also underlined the need to share information quickly and seamlessly using modern data standards.

Around ten years ago, Grahame Grieve, the founding father of FHIR, began work on a data standard that would enable on-demand information exchange. He was soon joined in this endeavor by Firely CTO Ewout Kramer and Lloyd McKenzie from Canada: together they developed the concept that became known as FHIR. 

FHIR is now owned and managed by HL7, a not-for-profit member organization, and licensed under Creative Commons as a free data standard that can be used without restrictions. 

What are the benefits of FHIR interoperability? 

FHIR facilitates the shift from hospital-centric healthcare to a patient-centric collaborative environment, so that clinicians and patients can get what they need and want from health IT systems. 

Patients can interact with multiple providers in different locations and healthcare settings, but still have a single personal health record that gives a comprehensive view of all their medications, problems, allergies, and consultations.

Governments around the world are promoting interoperability to improve healthcare outcomes and save money. In Germany, the ISiK (Informationstechnische Systeme in Krankenhäusern) federal law means hospitals must have compliant FHIR interfaces in place by June 2023, and in the US the 21st Century Cures Act calls on medical providers and IT developers to promote patient data access using FHIR-based apps and APIs. 

Why FHIR is so popular:

  • Fast and easy interoperability
  • Web-centric data exchange
  • Free to use, concise specifications
  • Familiar tools and protocols 
  • Support from major vendors 
  • Plenty of free online tools and open source libraries
  • Global, vibrant community driving the standard
  • Works for a wide range of use cases
  • Human-readable resource summaries

Familiar technology

FHIR is both a specification and an open, standardized web API. 

The FHIR API is based on established web standards including XML, JSON, HTTP, OAuth, and REST. Using these well-understood technologies lowers the barriers to entry and makes it easier and faster to implement, including for developers without prior healthcare IT experience. 

FHIR requests and searches are performed by RESTful HTTP commands, which return medications, observations, and patients represented by FHIR resources. A FHIR request can return a single resource, such as a patient’s personal details, a bundle of information, such as a care plan and medications, or a bulk data bundle for all patients in an EHR. 

It’s all about Resources

FHIR ‘resources’ or ‘data models’ are individual units of clinical and administration information, each with a unique identifying label similar to the URL of a web page.

These modular resources cover the data needs for the most common clinical use cases, and core information for most implementations. There are nearly 150 of them in the FHIR specification, defining patient, provider, organization, device, medications, diagnostics, care plans, and finance. They can be used alone or bundled into clinical documents, and each one carries a human-readable text summary.

Resources can include references to each other, in order to build a clinical story. The FHIR specification provides these “base” resources, but applications can add more control and meaning by using profiles. 

FHIR profiles – a neat way to customize resources

All FHIR resources can be “profiled”, meaning they can be restricted or extended to precisely fit your needs or use case, just so long as the data model remains compatible with the base standard. 

Extensions can be used to extend the data elements in a resource or add new ones: in the Patient resource, for example, those might be gender identity, religion, place of birth, or patient consent. They keep things simple and avoid cluttering up the core specification, while still meeting the specific requirements of a given workflow. 

A nice example of profiling in practice is the definition of a patient, published by HL7 UK in collaboration with the NHS (National Health Service). Here’s a ‘tree view’ of the UK patient resource with the differences between the UK patient and the base FHIR patient highlighted. Any developer working with NHS APIs needs to use this data model. 

UK Core Patient tree view
Example of profiling in practice

Our platform hosts more than 25,000 FHIR profiles from around the world; and to help you build a FHIR data model that precisely fits your use case, Firely has created Forge, the most comprehensive FHIR profiling solution on the market.

Where does Firely come in?

As one of the initiators of FHIR, Firely builds FHIR software that helps our customers use FHIR effectively and efficiently. We also offer FHIR training, run FHIR DevDays, and host, the global FHIR collaboration and publication platform. And you can power your online portal, app, or database with our turnkey FHIR Server.

The FHIR Community

FHIR is published as a hybrid standard with normative (settled) portions, and parts that are still undergoing trial use. Its impact on global healthcare owes a lot to enthusiastic international support and collaboration. 

Providers, developers, and vendors have all created tools that use the FHIR data standard and connect-a-thons and FHIR-based app challenges have helped to pick up the best and brightest ideas from the health IT community.

The use cases for FHIR are almost limitless and address the big healthcare challenges such as patient engagement and intelligent clinical decision support. FHIR is currently being used to:

  • Improve population health management
  • Break down data silos
  • Create new clinical decision support models
  • Create apps for free movement of data between EHR systems
  • Work towards seamless data exchange
  • Pull data from different sources to improve clinical decisions
  • Curate anonymized data for research and quality assurance

What’s next for FHIR?

All technology advances need good timing to succeed. FHIR came along at precisely the right moment, when there was growing awareness of the issues caused by lack of interoperability and the inability of existing standards to resolve them. It takes the best existing health IT and common internet standards and extends them to create a full interoperability solution for healthcare.

One of the areas where FHIR is likely to play a big role in the future, is in leveraging patient-generated health data (PGHD). Wearable health devices and trackers create an immense amount of health information every day but very little of it finds its way into clinical workflows. FHIR is already embedded in Apple’s iOS, and by bringing healthcare closer to other internet-based experiences it could be the missing link that makes millions of devices clinically useful. Apps built on a FHIR platform could analyze this PGHD data to improve chronic disease management and health in general. 

With release 5 due in 2023, FHIR is destined to become the underlying standard on which health apps and APIs are built. 

Want to learn more about FHIR? Register now for our three-day FHIR Overview Course.

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