Digital Health 101January 31, 2022

HL7 and the FHIR Standard

Capable Health Team

Ten years ago, nine of 10 U.S. doctors updated patient records on physical paper, storing them on site in file boxes. Today, more than 96 percent of office-based physicians have adopted and use an electronic health record (EHR) system. With this significant shift to digital records, many healthcare organizations are increasingly concerned about the privacy and security of patient data and how it can be exchanged seamlessly, accurately, and on-demand via these systems. Luckily, there are standards and resources available to help facilitate a more effective information exchange.

What Is HL7’s FHIR?

Healthcare data is highly complex, even more so now that it is mostly digital and stored in an electronic health record (EHR) or electronic medical record system (EMR system). Because of this shift, healthcare organizations need their data to travel across sometimes disparate systems, which can make upholding data integrity a challenge. The Fast Interoperability Healthcare Resource (FHIR) standard was created with this in mind—it aims to provide resources that help define healthcare information content and structure during system implementation, as well as in day-to-day practice. It becomes an essential protocol when joining or communicating across systems.

The increased push to digitize health records left much of the data on proprietary systems, essentially siloed and without the ability to exchange the data. FHIR lets patients access their electronic health records (EHRs) even amongst various providers

At its most basic, this standard aims to define how healthcare information can be exchanged between various computer systems, regardless of how the data may be stored. When followed, the FHIR helps medical workers securely and more easily access healthcare information, such as clinical and administrative data, and ultimately, can help improve patient care and outcomes. The FHIR is based on internet standards and practices outside of healthcare and is viewed as the best approach for how critical information can be shared. 

According to the The Office of the National Coordinator for Health Information Technology, benefits of FHIR for software developers include:

  • A focus on fast and easy implementation, as well as simple interfaces being implementable in a single day.

  • That it is complementary to use with no restrictions.

  • There is support from major browser vendors and most EHR vendors.

  • There are many free downloadable tools available (like reference servers and implementation libraries).

  • Examples are available to help kick-start development of new apps. 

  • Base resources can be used as is, but can also be customized for local requirements.

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

  • A global community to assist implementers.

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What Is the Difference Between HL7 and FHIR?

FHIR was created to cut through the complexity of transmitting healthcare data. The standards aim to define patient information and influence how data is structured during implementation. While these standards are widely adopted and used by developers today, what sets the FHIR apart is its flexibility, as it can be referenced for an individual task or bundled into a broader implementation project. 

The organization that sets this standard and provides guidance is called Health Level Seven International (HL7),a not-for-profit that offers frameworks and standards for healthcare organizations that are exchanging, integrating, sharing and retrieving electronic health information. The goal of providing these standards is to help support clinical practices in the management, delivery, and evaluation of health services.

HL7 drafted and developed the FHIR, and with this guidance, the international organization aims to empower health data interoperability across the globe, and ultimately, help ensure everyone—providers and patients—can access and use the right healthcare data whenever they need it. For a long time, interoperability was primarily based on documents—and whether they were faxed, emailed, or distributed virtually was determined by the healthcare provider. Now, patient information is exchanged across multiple EHR systems, which without a common standard would not be able to communicate compatibly, and healthcare organizations must coordinate care plans seamlessly. 

How to Create a PostgreSQL Database from FHIR HL7 JSON Files

Because healthcare data is highly complex, the FHIR standard takes a modern approach to connecting discrete data elements. The idea is that by clearly defining information content and structure, a core set of resources can solve for the majority of use cases during EHR system implementation. This is intended to help developers build standard “browser” applications no matter what healthcare system is powering them and which other systems they need to communicate with.

FHIR is intended for all kinds of users, but is designed to give developers and engineers an interface using technologies and standards that are common and familiar. FHIR helps new devs to build healthcare related apps.

The FHIR specification serves as the standard for exchanging healthcare information electronically, and through application programming interface (API) standards, the FHIR API helps developers build applications that connect to an EHR system’s operating system. The HL7 provides a detailed resource list to help technical teams determine how to start this process, as well as background on its data formats (XML and JSON) and extensibility. FHIR also has a bulk access implementation feature, allowing organizations to export large segments of data to aid in monitoring, analysis, and research.

FHIR uses RESTful principles to create, read, and update records and anyone making a request to a patient’s record will receive a JSON response with the relevant information rather than the entire record.

Before developers can begin using the FHIR database, they need to install a postgreSQL database first, which is a reliable, open-source system that can store data across many different applications. The JSON file stores simple data structures that transmit data from the FHIR into a system’s EHR. The best place to learn more about this technical process and get started is by reading through the HL7 resource list, as well as the patient resource definition guide.

How Does HL7 FHIR Support Data Governance?

The FHIR standard covers the complete lifecycle of an EHR system implementation, including the development, adoption, utilization, and active adherence to its standards. The HL7 Governance and Operations Manual (GOM), for example, aims to help healthcare organizations uphold the uniformity, quality, efficiency, and compliance of patient data. This manual is regularly reviewed, and the HL7 encourages its members to be proactive in regard to staying in compliance with the data governance model after implementation.

The data governance manual picks up exactly where the FHIR standard ends—the key categories of the HL7 include:

  • Primary standards: The primary standards include the core standards needed for system integrations, interoperability, and compliance. These are the most frequently referenced standards.

  • Electronic health records: This enables the constructs for managing electronic health records.

  • Arden syntax: This procedural clinical knowledge helps facilitate the sharing of digital health records.

  • Clinical context management specification: This section helps facilitate the integration of applications as they are being used.

  • Clinical and administrative domains: These standards are usually implemented once primary standards for an organization are in place.

  • Implementation guides: All documents in this section serve as supplemental material for a parent standard.

  • Rules and references: These are technical specifications, programming structures and guidelines for software and standards development.

  • Clinical document architecture 

  • The FHIR

  • Cross-paradigm/domain analysis models

While the standards used for the successful use and communication of digital healthcare data are complex, FHIR continues to change how developers view and create the underlying infrastructures that support patient care. 

The majority of healthcare organizations now use an EHR system to exchange patient data seamlessly, accurately and on-demand, and the applications powering this technology constantly evolve how they look, feel, and operate to meet changing patient needs. 

As more patient information is exchanged across multiple EHR systems, healthcare organizations need to continue to expand and improve how they coordinate care plans digitally. Developers have an opportunity to shape health data interoperability, and HL7 and the FHIR standards are a core part of how they will continue to do so.

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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