FHIR (Fast Healthcare Interoperability Resources)

FHIR (Fast Healthcare Interoperability Resources)
Name	FHIR (Fast Healthcare Interoperability Resources)
Developer	Health Level Seven International
Released	2011
Latest release	R5 (release status varies)
Written in	Extensible Markup Language, JavaScript Object Notation
License	Creative Commons

FHIR (Fast Healthcare Interoperability Resources) is a standards framework for exchanging healthcare information electronically that originated with Health Level Seven International and draws on prior work from HL7 Version 2, HL7 Version 3, and Clinical Document Architecture. It defines modular "resources" to represent clinical, administrative, and infrastructural data for use by developers at organizations such as Mayo Clinic, Kaiser Permanente, National Health Service (England), and Centers for Medicare and Medicaid Services. FHIR is widely used in programs involving vendors like Epic Systems Corporation, Cerner Corporation, Allscripts, and initiatives led by Office of the National Coordinator for Health Information Technology and European Commission digital health projects.

Overview

FHIR combines web technologies adopted by projects at Google, Microsoft, Amazon Web Services, and IBM with healthcare domain models created by HL7 International committees, enabling applications across settings such as Johns Hopkins Hospital, Cleveland Clinic, Mount Sinai Health System, and Veterans Health Administration. The framework supports representation of data elements comparable to artifacts from ICD-10, SNOMED CT, LOINC, and RxNorm, and leverages transport patterns used by Representational State Transfer APIs championed by companies like Twitter and Facebook. Its ecosystem includes toolkits and libraries maintained by groups including IHE (Integrating the Healthcare Enterprise), SMART on FHIR, OpenEHR, and academic centers such as Stanford University and Harvard Medical School.

History and Development

FHIR emerged from HL7 initiatives influenced by projects at MIT, Carnegie Mellon University, and the University of California, San Francisco aiming to simplify integration after experiences with HL7 Version 2 and HL7 Version 3 implementations at sites like Geisinger Health System. Key contributors included committees within Health Level Seven International and collaborators from organizations including World Health Organization, Centers for Disease Control and Prevention, Office of the National Coordinator for Health Information Technology, and national health agencies such as Australian Digital Health Agency. Development milestones reflect working groups that met alongside conferences like HIMSS Conference, RSNA annual meeting, and Healthcare Information and Management Systems Society events, and were influenced by interoperability initiatives like Meaningful Use and the European Interoperability Framework.

Specification and Core Concepts

The specification defines interoperable constructs informed by modeling efforts at ISO, IEEE, and W3C standards bodies, including use of XML and JSON serializations, and HTTP interactions seen in specifications from IETF. Core concepts include resources, profiles, extensions, and RESTful APIs similar to designs used by GitHub and Stripe. Profiles and conformance statements draw on terminology bindings from SNOMED International, Regenstrief Institute for LOINC, and National Library of Medicine for RxNorm mapping. The FHIR governance process involves ballot cycles and stewardship by Health Level Seven International and cooperating organizations such as HL7 Brasil, HL7 UK, and HL7 Australia.

Resource Types and Data Model

FHIR defines resource types that model entities familiar in clinical systems deployed at institutions like Boston Children's Hospital and Dana-Farber Cancer Institute: for example, Patient, Observation, Condition, MedicationRequest, and DiagnosticReport. Resource relationships are designed to support data flows used in programs run by Centers for Disease Control and Prevention and National Institutes of Health, and to interoperate with terminologies administered by SNOMED International and World Health Organization. Developers from companies such as Red Hat, Oracle Corporation, and Salesforce have built tooling to manipulate these resources, while academic projects at Johns Hopkins University and University of Toronto have analyzed the FHIR data model for research uses.

Implementation and Adoption

FHIR adoption is promoted through programs by Office of the National Coordinator for Health Information Technology, procurement by national ministries like NHS England, and vendor implementations by Epic Systems Corporation and Cerner Corporation. Notable implementations include health information exchanges used by Carequality and CommonWell Health Alliance, research networks run by PCORI and All of Us Research Program, and international pilots led by European Commission and World Health Organization. Developer communities at GitHub, open-source projects such as HAPI FHIR and Firely toolsets, and standards outreach at conferences like HIMSS and RSNA accelerate adoption across hospitals like UCSF Medical Center and national systems such as Canadian Institute for Health Information.

Security, Privacy, and Governance

Security and privacy models for FHIR reference mechanisms and frameworks from NIST, Office for Civil Rights (OCR), and regulations such as Health Insurance Portability and Accountability Act and national data protection authorities like Information Commissioner's Office (United Kingdom). Implementation guides frequently incorporate authentication and authorization patterns including OAuth 2.0 and OpenID Connect promoted by Internet Engineering Task Force, and align with governance frameworks used by European Medicines Agency and FDA. Health organizations including World Health Organization and Centers for Disease Control and Prevention collaborate with standards bodies to craft policies for consent, data minimization, and audit logging in FHIR-based systems.

Challenges and Future Directions

Challenges include semantic interoperability issues seen in historical projects at Veterans Health Administration and terminological mapping work by Regenstrief Institute, as well as governance and liability concerns addressed by agencies such as Office of the National Coordinator for Health Information Technology and courts referenced in cases involving Department of Health and Human Services. Future directions involve integration with health data science platforms at MIT, University of California, Berkeley, and ETH Zurich, incorporation of models from openEHR and ISO standards, and enhanced support for real-time workflows used in telemedicine deployments by Teladoc Health and public health surveillance led by World Health Organization and Centers for Disease Control and Prevention.

Category:Health informatics standards