Digital Health 101January 2, 2022

What is FHIR?

Adam Tudor

The Fundamentals of FHIR

What is FHIR?

The Fast Healthcare Interoperability Resources (more commonly known as FHIR) is an open standard that facilitates the exchange of healthcare information between different computer systems regardless of how those records are stored. In the past decades, healthcare providers  have been pushed to digitize health records which have led to a siloing of patient information with limited ways to exchange data between them. FHIR aims to solve this problem by allowing patients to access and navigate their electronic health records (EHRs) from their various healthcare providers. 

For over 20 years, the Health Level Seven International (HL7) healthcare standards organization has been addressing digital challenges by producing data exchange and information modeling standards for the healthcare community. FHIR is a new specification designed using modern web standards to simplify this exchange of clinical and administrative data without compromising confidential patient information.

How does FHIR work?

FHIR standards are built from a set of modular components called “Resources,” which contains relevant data and links to related resources. FHIR specification uses RESTful principles to create, read, and update records. Anyone making a request to a patient’s record will receive a JSON response with the relevant information rather than the entire record.

There are common resource types such as “Patient,” which covers data about a wide range of health-related activities including psychiatric care and social services, “Observation” to track vital signs, and “Medication Prescription,” which details the order, supply, and instruction for administration for medications. Resources are extensibile, that is, creators did not originally envision the use case for all resources and wanted a way to add future functionality. This is done through a foundational component of “Extensions.” A well defined and governed component of FHIR which helps ensure interoperability and simplicity for everyone.

Extensions can be used to create custom resources known as profiles. A common profile is the US Core Profile which defines profiled resources that have elements that are important in the United States. For example, it adds “race” and “ethnicity” to the patient resource. Profiles are a core component of FHIR and enable flexibility while maintaining structure and interoperability. 

Where can FHIR be used?

A patient’s health information is highly confidential—in the United States HIPAA protects patient data—and as such, the FHIR makes such data securely available to those who have the right to access it for the benefit of patients needing care. FHIR is used in health information exchanges, electronic health record (EHR) systems, for interoperability across healthcare organizations, integration with payer systems, and web applications and portals for patients and clinicians.

FHIR does not have a security protocol or is opinionated on how to store data. However, it does define an “Audit resource which helps track the origins, history, status, and access of resources as well as user/client authentication to correctly identify people, devices, locations, and organizations that access the data.

Why is FHIR important?

FHIR is essential to both healthcare institutions and patients as it allows for easy exchange of electronic health records between legacy systems. Prior to such standards, when one organization’s EHR system shared records with another organization using a different EHR system, the data could be rejected, altered, or corrupted to the point of being unusable by recipients. Built on and modified with previous clinical and administrative data specifications, FHIR standards address these interoperability issues effectively and EHRs can now be exchanged without issue.

With the FHIR standards, patients are also able to obtain their own medical records, providing greater clarity and data ownership for patients seeking to understand conditions and treatment in order to make sound decisions about healthcare options and providers. 

One important element in the wide-spread adoption of FHIR was the Office of National Coordination for Health Information, which published rules and regulations requiring EHR vendors to adopt FHIR. This meant that, rather than allowing EHRs to create and use proprietary methods that would have left health data siloed, a common standard for all was adopted. 

Perhaps most importantly, FHIR facilitates compatibility with any device, smartphone, or laptop allowing medical records to be accessed whenever and wherever needed.

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How is FHIR implemented

FHIR is a standard that is implemented by various EHR providers as a way to provide a standard interface to access the patient data they hold. FHIR is intended for a variety of users, but designed to give engineers an interface using technologies and standards they are familiar with FHIR significantly reduces the barriers for new developers to build healthcare related apps. 

The FHIR standard provides the following advantages for software developers:

  • Open access with no restrictions

  • Support from major EHR providers

  • Downloadable, online tools including reference servers and implementation libraries

  • A strong foundation in web standards including XML, JSON, HTTP, and OAuth2

  • Concise and comprehensive online specifications

  • A serialization format for ease-of-use

  • A global community to support and assist implementers 

How Has FHIR Been Applied in Healthcare?

Healthcare’s digital transformation is essential to providing effective patient care and FHIR standards bridge the gap between parties requiring access to patient data. Not only has the FHIR standard made the digitization of health records and secure access to patient information easier and more widespread, the standard is iterative, promising future advancement and ease of use. Here are a few of the ways that the standard is being applied.

Easier data analysis 

One of the core benefits of FHIR is that it standardizes and simplifies the exchange of healthcare data. It combines the features of HL7 with the latest web standards such as XML, HTTP, Atom, JSON and OAuth2. Differing data formats can make analysis challenging, but the FHIR uses APIs to simplify the system integration module, producing a faster and better way to transfer and analyze medical records. Additionally, FHIR has bulk access implementation to allow organizations to export large segments of their patients to aid in analysis and reporting. Organizations gain access to a wealth of data that can lead to optimizations and ultimately better health outcomes.

Providing accurate data

When data is exchanged without the use of FHIR standards, there’s a higher likelihood of error that could produce inaccurate diagnoses and improper treatments for patients. For instance, research shows that up to 80% of patient allergies aren’t accurately coded in electronic health report systems, which means that providers may have insufficient or incorrect information about patients before prescribing or administering drugs that could cause adverse reactions. Accurate data provided by FHIR plays an important role in preventing mistakes, saving patient lives and administrators money, as well as maintaining trust and confidence in healthcare organizations.

Less effort for patients

With FHIR, it’s less likely that patients will be required to complete duplicate intake forms each time they visit a new provider. This is because interoperability allows institutions to exchange data freely and gain access from anywhere. Similarly, medical personnel needn’t spend time on onerous paperwork in order to transfer data, send and receive faxes, or on manual data entry into duplicative systems—the result of which is more efficient allocation of resources and improved service to patients.

Preventing billing errors

Statistics show that billing mistakes cost hospitals over $68 billion annually. Data errors can also impact billing. With the free data exchange via FHIR, medical institutions can decrease billing errors by detecting duplicate billing, verifying correct data entry, and avoiding inadvertent upcoding or undercoding. Smooth data transfer leads to better patient management as well as improved business outcomes. 

What Is SMART on FHIR?

The adoption and implementation of FHIR by developers has given rise to a project called Substitutable Medical Apps, Reusable Technologies (SMART). Designed by a team of software engineers and clinicians at Harvard Medical School and Boston’s Children Hospital, SMART was launched in 2010 to develop a standards-based app platform for healthcare. 

Because the SMART project shared goals with FHIR, both initiatives were aligned as one project known as SMART on FHIR. With this alignment, FHIR provides a standard set of data models, which SMART builds on to integrate apps with EHRs using those data standards.

How is SMART on FHIR applied in healthcare?

SMART on FHIR represents best practices in digital health data exchange, using the secure OpenID Connect identity management protocol, allowing applications to request access to clinical data. SMART uses the FHIR standard to read and update that data, and also describes a consistent Uniform Resource Locator (URL) scheme for EHRs to use for launching web-based applications with a set of data being passed to the application. 

The SMART project maintains an app gallery where software developers can showcase their latest products and healthcare providers can test SMART-compatible apps. It also provides resources for building applications that can run on the SMART platform, including a list of app development companies and suitable tech stack for health apps. SMART provides many opportunities for healthcare organizations to optimize how they use EMR systems. You can find an EHR systems list here. 

Help With FHIR

Drawn by its usability, FHIR is utilized by healthcare developers around the world, and represents a milestone in removing barriers to healthcare data exchange.

At Capable Health, our goal is to decrease the complexity of FHIR, removing worries about the details of FHIR extensions and profiles for healthcare builders, enabling them to launch and scale the patient experiences that drive real improvement in patient care. 

Capable Health is a purpose-built developer platform to build best-in-class consumer health apps, the first API-driven platform dedicated to powering patient onboarding and engagement. Capable takes care of signup, onboarding, care plans, goal tracking, content delivery, secure messaging—the API middleware powering modern patient-facing healthcare experiences.

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