What if We Created a New Interoperability Standard From Scratch?
Fast Healthcare Interoperability Resources (FHIR®) is the newest standard from Health Level Seven International (HL7®). The concept that became HL7 FHIR was first discussed in 2010 in response to a question posed to an HL7 task force: What if we created a new standard from scratch, what would it look like?
The Meaning of Interoperability has Changed
The amount of data about an individual’s health and healthcare has grown exponentially over recent decades, and continues to do so. That data is no longer just in clinics and hospitals, but comes from an increasing number of sources. “Interoperability” used to mean connecting two or more systems. Now it means accessing data in multiple systems from one point, one client, in real time. This is how many of the web applications we use today function – social media, e-commerce, financial services, and much more. In a similar way, FHIR is the technology that will allow us to see all of an individual’s health and healthcare data in one view.
Interoperability Done Differently with FHIR
FHIR is based on the same technology as mobile and web applications in other industries and on the definition of data elements and concepts in healthcare. Past HL7 standards have been published in multi-month cycles as documents. These documents required interpretation by implementers to create software applications. FHIR has instead followed the processes of open source development, relying on wikis and social media and an online draft of the standard that is publicly accessible. Development has also been driven by FHIR connectathons that are an integral part of the development process.
Rapid Adoption of FHIR
With the 3rd release of the FHIR specification in early 2017, FHIR has already seen significant adoption. Implementers have created FHIR interfaces and applications across a broad range of use cases. They range from enabling clinicians to access data in their own systems with mobile apps, to using FHIR to pass patient context from an EHR to decision support services, to identity matching and records discovery.
Our Products and Solutions Support FHIR
InterSystems has incorporated FHIR capabilities into its current releases of InterSystems HealthShare. HealthShare typically aggregates data from multiple electronic health records and other types of systems – even those that may only expose their data using legacy interfaces.
Through HealthShare all the data for an individual or a population can be transformed and aggregated as a FHIR representation, and applications developed with FHIR can access it. This FHIR repository of data allows applications based on the latest technology to use that data for patient care, value-based care, quality improvement, research, and other use cases.
Fast Healthcare Interoperability Resources (FHIR) is the next generation HL7 standard. Three years after the first release of FHIR, it has remarkable uptake and is being implemented for a broad range of use cases. Yet beyond those involved in developing the standard, and the early innovators using it, knowledge about FHIR is limited. The content below provides more information about FHIR and what people are doing with it.
Without being technical, this video starts from the considerations that inspired development of a new standard and explains the fundamental concept of FHIR and its basic components.
Exciting Potential for Clinicians
Due to the ease and speed with which FHIR applications are created, and the availability of FHIR as a public API (Application Programming Interface), the potential of FHIR for clinical care is extraordinary. This video reviews the basics of FHIR and the aspects that give the FHIR standard great potential for clinical care.
What People are Doing with FHIR
Thanks to the combination of FHIR and a platform for healthcare apps developed by Harvard called SMART (Substitutable Medical Applications, Reusable Technology) there is already significant uptake of FHIR and implementations across many use cases within clinical organizations. This video highlights 3 such apps that are representative of 3 types of use cases.
What is SMART and What Were its Origins?
SMART (Substitutable Medical Applications, Reusable Technology) is a platform architecture for healthcare applications that is based on open source standards. This platform was developed by Boston Children’s Hospital and Harvard Bioinformatics beginning in early 2011. The basic components are an open API, one or more “data containers” with the primary one usually an EHR or data warehouse, single sign-on enabled by OpenID Connect, and security with OAuth. An open API was developed for basic elements of clinical data as part of the project.
How did SMART become SMART on FHIR?
In 2013 representatives of SMART met with representatives of the HL7 FHIR community, and SMART on FHIR was born. The SMART platform adopted FHIR as the API for clinical data for SMART, as FHIR was evolving as a standardized open API for clinical data. The adoption of SMART on FHIR apps accelerated as the Argonaut Project, a vendor-led project initiated by HL7, has developed public FHIR profiles based on data models that include specified vocabularies for medications, labs, problems and other fundamental clinical data.
Where Can I Find More About SMART on FHIR?
Part of the SMARThealthIT.org site is an app gallery for SMART apps. There is also a set of tools for developers including open source libraries and a sandbox. The gallery includes some 50 apps that are available; some are open source and free, some are not. Existing SMART on FHIR apps include some that are for mobile devices and some that are web apps that launch from within an EHR workflow. The overarching feature is that these are portable apps that with little modification can be deployed in any SMART on FHIR enabled system.
How does InterSystems technology support SMART on FHIR?
With its current release, InterSystems HealthShare is the first SMART-on-FHIR-enabled HIE environment creating a platform for SMART on FHIR mobile apps. SMART on FHIR apps can also launch from within the HealthShare Clinical Viewer, allowing SMART on FHIR apps to access the data in an individual’s composite record, not just content from a single EHR.
What other new developments are there in SMART on FHIR?
The SMART on FHIR effort continues to evolve. Developments in the areas of genomics and CDS (Clinical Decision Support), for example, leverage the FHIR API to access data in an EHR or HIE. This data is used to provide patient context for results coming from genomics sequencing labs or clinical knowledge bases.
Learn More About FHIR
Healthcare interoperability is instrumental in improving patient care, decreasing healthcare provider costs, and providing a more accurate patient picture to providers. FHIR, or Fast Healthcare Interoperability Resources, is a new healthcare data standard that aims to solve some of the problems affecting previous standards, including HL7v2, HL7v3, and CDA.
Here’s a brief overview video describing FHIR, FHIR resources, FHIR requests, and examples.
This video provides an overview of the structure of FHIR data, including resources, bundles, and extensions.
SMART on FHIR
SMART — short for Substitutable Medical Apps & Reusable Technology — is a platform for plug-and-play apps that can be reused. SMART on FHIR provides a platform for FHIR apps, such as a Bilirubin Chart, interactive growth chart, or Diagnostic Clinical Decision Support, that use FHIR to provide specific pre-built application functionality. SMART on FHIR is not the only way that FHIR is used.
The FHIR Group is for FHIR developers and those who have an interest in understanding more about developing FHIR solutions. The group is a place for discussion and finding answers to questions about FHIR implementation using InterSystems technology. Whatever your reasons for joining, the group shares the same spirit of open collaboration and cooperation that has been a driving force in the rapid advancement of FHIR. You’ll find a knowledgeable FHIR community and a willingness to answer your questions, whether they are from the perspective of someone new to FHIR or an established developer.
InterSystems Learning Services
Check out Learning Service’s offerings for more information: a FHIR resource guide, including online courses, documentation and presentations.
RESTful FHIR & Messaging in Health Connect
Hands-on with FHIR
Warm up by exercising RESTful FHIR & messaging in HealthShare Health Connect.
In this exercise you will use Health Connect messaging and FHIR data models to transform and search for clinical data.
First step, transform an HL7 Consolidated-CDA document into discrete FHIR resources using Health Connect’s off-the-shelf components. Then POST those resources to a FHIR server and use a REST testing tool to search for individual pieces of clinical data. In the optional bonus exercise, you will bring new life to old HL7 v2 messaging by transforming an HL7 v2 message data into FHIR resources.
This experience was originally hosted in-person for attendees at the InterSystems Global Summit 2017.
HL7, FHIR and the FHIR are the registered trademarks of Health Level Seven International.