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FHIR: The Springboard to True Interoperability
By Dhaval Shah and Manisha Bafna

Fast Healthcare Interoperable Resource (FHIR)—the next generation standard framework created by Health Level Seven International (HL7)—has the potential to be as ubiquitous and useful as the internet itself—the dot-com revolution for health care. What makes FHIR so important?

In the same way people around the world use the internet to access a URL using any standard browser and web-enabled device, FHIR intends to facilitate the sharing of health care records. It has the potential to enable users to access health care-specific, well-defined, structured pieces of data regardless of the underlying infrastructure or operating system.

Over the next several years, FHIR implementations are expected to overcome the majority of the complex limitations of current HL7 standards and provide a much-needed springboard for simplifying interoperability.

FHIR Accelerates Interoperability
The health care technology community views FHIR as the preferred and universal standard for data exchange because it enables faster access to data while keeping the basics of interoperability workflows intact. For example, if a cardiologist wants to access a specific image, FHIR makes it easier for systems to retrieve only that specific piece of information without retrieving all the details related to that image. This powerful data-centric approach employs secure, open internet standards that enable developers to innovate faster, making flexible and efficient access to patient data possible.

FHIR Delivers Key Advantages
Previous HL7 standards—v2.x, v3, and Clinical Document Architecture (CDA)—had significant limitations in terms of non-XML segments and esoteric or complex implementations. FHIR is expected to overcome the majority of these limitations with the following inherent advantages:

• RESTful architecture. Resources can be accessed over HTTP and served in XML or JSON format, similar to web pages, while allowing granular-level access to even a single data element. This also allows servers to perform a bulk of calculations, which reduces computing time efforts on the client side.

• Multiple paradigms. Paradigms for messaging (v2, v3) and documents (CDA) are all supported.

• Human readability. Like CDA, resources have human-readable explanations embedded along with the XML/JSON data.

• Open-source. Authentication is provided by the OAuth2 standard, and payload security is handled by HTTPS.

• Querying. Resources can be searched using various parameters, similar to a Google search, using REST commands and only the required details are retrieved.

• Support. Extensive documentation, examples, test servers, and development platforms are available as well as workgroups and communities.

Value to HIT
FHIR holds enormous potential to facilitate data access for key HIT systems, including EHRs, medical imaging, and lab and payer systems, as well as health information exchanges (HIEs).

EHRs, imaging, and lab systems contain information critical to patients, physician practices, and hospitals. Yet, most of these systems function as silos using proprietary technology that makes it difficult to interface with each other and with other systems. For example, even with the DICOM standard for imaging data, most images continue to be shared via time-consuming and labor-intensive CDs.

FHIR enables these systems to securely expose patient data through resources on the web and allow other systems access using HTTPS and OAuth2 authentication. What's more, only the specific data needed can be accessed, so only the image metadata can be retrieved instead of the whole image, lab reports can be retrieved without fetching encounter data, and patient medications can be retrieved without fetching demographics. This creates an 'internet' of HIT systems where any data related to a patient can be retrieved from any system, and applications can then leverage patient data for health monitoring, business intelligence, predictive analytics, and much more.

Payer systems have similar challenges such as creating inefficient enrollment, eligibility, and claims processes. FHIR exchanges data efficiently at each stage so that individual data elements are accessible over HTTP and are kept up to date along with change history.

Lastly, although HIEs are designed to make data available from disparate sources in a network to all participating systems, third-party devices may still have trouble accessing information due to, eg, authentication issues, communication protocols, and standards used. FHIR-enabled HIEs can expose data to third-party devices by dynamic authentication and enable any device to query information at a more granular level than C-CDA, for example, when a physician requests access to current medications.

Across the board, FHIR increases speed, facilitates interoperability, and reduces the costs and required bandwidth for HIT systems.

The Market Is Already Embracing FHIR
FHIR has seen extensive support from leading vendors who are part of the Argonaut project, a private sector initiative (under the aegis of HL7) made up of more than 11 organizations, including Epic, Cerner, and McKesson, working together to drive FHIR development. One such project is the SMART on FHIR (an open platform architecture) developed by the Boston's Children Hospital and supported by Cerner. In the government sector, the Centers for Medicare & Medicaid Services currently uses FHIR to modernize Blue Button and is considering including FHIR in future rulemaking.

As the HIT industry continues to evolve in response to market and regulatory pressures, the need for true interoperability will increase. FHIR can help the health care industry overcome the majority of the complex limitations of current standards, while reducing costs, accelerating interoperability, enhancing scalability, improving patient engagement, and enhancing overall quality of care.

— Dhaval Shah is senior vice president at CitiusTech.

— Manisha Bafna is associate vice president at CitiusTech.