Fast Healthcare Interoperability Resources (FHIR) is a draft standard developed by Health Level 7 (HL7) for exchanging electronic healthcare information that aims to make it faster and simpler to develop interoperable healthcare applications. Jump to resource links -->

What are the FHIR Standards?

The FHIR standards are proposed interoperability standards that outline how data should be formatted and shared. Built around the HL7 Version 2 and HL7 Version 3 standards, FHIR is based on current web programming standards such as JSON and API (Application Programming Interface) technology.

The FHIR standards support several methods for exchanging information, including:

  • RESTful API
  • Messaging
  • Documents
  • Services
  • Database/persistent storage

REST APIs are the standard used on the Internet to share and exchange information. Using REST APIs, FHIR allows information to be accessed in a similar way to using a URL to access a web page. Developers can connect applications quickly to obtain the data needed, and applications developed using FHIR standards make it possible for healthcare providers and clinicians to access health information from their preferred device, such as a tablet or smartphone.

How FHIR Works

FHIR is built around a concept of resources, which are then used as the building blocks that are incorporated into existing systems. FHIR supports many resource types, some of which describe entities and roles, such as patients, practitioners, and medications.

FHIR implementation also encompasses the relationships between resources and the actions that can be taken on them, as well as relationships between actions. In addition to the resource types that describe entities and roles, others describe activities, which are involved in workflows. These include definitions of things that can be done, requests asking for or indicating a desire for something to be done, and events, which describe things that have been done.

Use Cases for FHIR in Healthcare

FHIR has a broad intended scope, and there are a variety of possible use cases for FHIR in healthcare, such as:

  • Human health
  • Veterinary health
  • Clinical healthcare
  • Public health
  • Clinical trials
  • Healthcare administration
  • Healthcare finance

For example, FHIR can be used to make personal health records (PHR) accessible to patients for use in other applications, such as fitness applications or personal health monitoring applications. FHIR can be used to support document sharing in healthcare, such as sharing lab reports and imaging results with other clinicians across health systems. It can also be used in decision support systems, such as checking for possible drug interactions.

FHIR Implementation

According to HL7, “FHIR aims to simplify implementation without sacrificing information integrity.” When organizations or applications implement the HL7 standards in different ways, it inhibits data exchange and requires additional translation layers, which are both costly and time-consuming to develop. FHIR implementation is easier for developers to learn and develop, so it’s faster to implement compared to the HL7 standards.

However, one primary challenge of HL7 implementation exists for FHIR implementation, as well: Organizations or applications can implement different versions of FHIR, only some FHIR APIs, or partial FHIR APIs, resulting in systems that are not interoperable, despite both systems using FHIR.

While FHIR gets the healthcare industry closer to the ultimate goal of interoperability, it’s not yet the complete solution. FHIR Release 4, released in 2019, includes a normative base with backwards compatibility, which aims to give developers and organizations confidence that FHIR implementations they undertake will be supported for the foreseeable future and allow developers to implement FHIR more consistently and uniformly. While FHIR Release 4 is the current published version, development on Release 5 is underway with the hope of getting even closer to interoperability.