User:Tertius3

{{short description|Standard for exchanging electronic health records}}

{{Infobox technology standard

| title = Fast Healthcare Interoperability Resources (FHIR)

| long_name =

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| organization = HL7

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| base_standards = JSON, XML, RDF

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| abbreviation = FHIR

| domain = Electronic health records

| license = CC0

| website = {{URL|http://hl7.org/fhir/}}

}}

Fast Healthcare Interoperability Resources (FHIR, pronounced "fire") is a standard describing the data formats (known as "resources") and an application programming interface (API) for exchanging electronic health records (EHR) data. The standard was created by the Health Level Seven International (HL7) healthcare standards organization.

FHIR builds on previous data format standards from HL7, like HL7 version 2.x and HL7 version 3.x. But it is easier to implement because it uses a modern web-based suite of API technology, including a HTTP-based RESTful protocol, and a choice of JSON, XML or RDF for data representation.{{Cite web|url=https://www.hl7.org/fhir/|title=Welcome to FHIR|last=|first=|date=2019-11-01|website=HL7.org|publisher=|access-date=2021-02-12}} Resource definitions exist for all basic elements of healthcare like patients, admissions, diagnostic reports and medications, which can each be retrieved and manipulated via their own resource URLs.

One of its goals is to facilitate interoperability between legacy health care systems, to make it easy to provide health care information to health care providers and individuals on a wide variety of devices from computers to tablets to cell phones, and to allow third-party application developers to provide medical applications which can be easily integrated into existing systems. {{cite web

| url=https://www.hl7.org/fhir/overview.html | title=FHIR Overview | date=2019-11-01 |website=HL7.org | accessdate=2021-02-14 }}

The [http://hl7.org/fhir/2011Aug/ initial draft of FHIR], then known as Resources For Healthcare (RFH), was published by Grahame Grieve on his blog{{cite web|url=http://www.healthintersections.com.au/?p=502|title= Resources For Health: A Fresh Look Proposal|date=2011-08-18|accessdate=2019-08-22|author=Grahame Grieve|work=Health Intersections}} in August 2011.{{cite web|url=http://www.ringholm.com/column/FHIR_5_years.htm#targetText=The%20initial%20version%20of%20FHIR,the%20time)%20on%20his%20website|title=Five years of FHIR|date=2016-08-11|accessdate=2019-08-22|author=René Spronk|work=Ringholm}}

The standard was adopted by Health Level Seven International (HL7) as a work item in September 2011. A core team, consisting of Grieve, Lloyd Mckenzie and Ewout Kramer, supported by HL7 members, started the process of developing the initial FHIR release {{cn}}. From September 2012 onwards HL7 has been organizing tri-annual test events which have the intent to drive the standardization process forward and to test those parts of the standard that have a not been finalized yet {{cn}}.

In February 2014, HL7 published FHIR Release 1 as a "Draft Standard for Trial Use" (DSTU).{{cite news

|url=http://www.hl7.org/implement/standards/product_brief.cfm?product_id=343

|title=HL7 Fast Healthcare Interoperability Resources Specification 'FHIR™', Release 1

|work=HL7 International

|date=2014-02-02

|accessdate=2014-12-26

|url-status=dead

|archiveurl=https://web.archive.org/web/20141228095815/http://www.hl7.org/implement/standards/product_brief.cfm?product_id=343

|archivedate=2014-12-28

}}

FHIR Release 2 was published in October 2015, and FHIR Release 3 in March 2017, as the first "Standards for Trial Use" (STU) release. It included coverage of a variety of clinical workflows, a Resource Description Framework format, and a variety of other updates.{{Cite news|url=http://www.healthcareitnews.com/news/hl7-publishes-new-version-its-fhir-specification|title=HL7 publishes a new version of its FHIR specification|date=2017-03-22|work=Healthcare IT News|access-date=2017-03-30|language=en}}{{Cite web|url=http://hl7.org/fhir/directory.html|title=All Published Versions of FHIR|last=http://hl7.org/fhir|website=hl7.org|access-date=2017-03-30}}

FHIR Release 4, the first "normative version" was published on October 30, 2019.

FHIR is organized by resources (e.g., patient, observation).{{cite web|title=Fast Healthcare Interoperability Resources® (FHIR)

|publisher=eCQI Resource Center|url=https://ecqi.healthit.gov/fhir}}

File:FHIR resource graph.png

{

"resourceType": "Patient",

"id": "3736",

"text": { "status": "generated", "div": "

"identifier": [ { "use": "usual", "system": "http://www.goodhealth.org/identifiers/mrn", "value": "283471838" } ],

"active": true,

"name": [ { "use": "official", "family": "Chalmers", "given": [ "Peter", "James" ] }, ],

"gender": "male",

"birthDate": "1974-12-25"

}

Such resources can be specified further by defining FHIR profiles (for example, binding to a specific terminology).

{

"resourceType" : "Observation",

"id": "9082",

"text" : { "status" : "generated", "div" : "

"status" : "final",

"code" : { "coding" : [ { "system" : "http://loinc.org", "code" : "29463-7", "display" : "Body weight" } ], "text" : "Body weigth" },

"subject" : { "reference" : "Patient/3736" },

"effectiveDateTime" : "2016-06-14",

"valueQuantity" : { "value" : 85, "unit" : "Kg", "system" : "http://unitsofmeasure.org", "code" : "kg" }

}

A collection of profiles can be published as an implementation guide (IG), such as The U.S. Core Data for Interoperability (USCDI).{{cite web |url=https://www.healthit.gov/sites/default/files/draft-uscdi.pdf |title=Draft U.S. Core Data for Interoperability (USCDI) and Proposed Expansion Process |publisher=USA HHS |accessdate=27 November 2019}}

Because FHIR is implemented on top of the HTTPS (HTTP Secure) protocol, FHIR resources can be retrieved and parsed by analytics platforms for real-time data gathering. In this concept, healthcare organizations would be able to gather real-time data from specified resource models. FHIR resources can be streamed to a data store where they can be correlated with other informatics data. Potential use cases include epidemic tracking, prescription drug fraud, adverse drug interaction warnings, and the reduction of emergency room wait times.{{cite web

| url=https://www.extrahop.com/company/blog/2015/what-is-fhir-hl7-fast-healthcare-interoperability-resources/

| title=What is FHIR? And what does it mean for Healthcare IT Monitoring?

| date=2015-08-28

| accessdate=2015-08-28 }}

A number of high-profile players in the health care informatics field are showing interest in and experimenting with FHIR, including CommonWell Health Alliance and SMART (Substitutable Medical Applications, Reusable Technologies).{{cite news|url=https://www.forbes.com/sites/danmunro/2014/03/30/setting-healthcare-interop-on-fire/|title=Setting Healthcare Interop On Fire|date=2014-03-30|work=Forbes|author=Dan Munro|accessdate=2014-11-22}}

Open source implementations of FHIR data structures, servers, clients and tools include reference implementations from HL7 in a variety of languages, SMART on FHIR{{cite news

| url=http://www.mhealthnews.com/news/geisinger-moves-mobilize-its-ehr-platform | title=Geisinger moves to mobilize its EHR platform | work=mHealthNews | date=2014-11-11 | accessdate=2014-12-06 }} and [https://hapifhir.io/ HAPI-FHIR] in Java.{{cite web |url=http://wiki.hl7.org/index.php?title=Open_Source_FHIR_implementations |title=Open Source FHIR implementations - HL7Wiki

|accessdate=2014-12-06 |url-status=dead |archiveurl=https://web.archive.org/web/20141220063122/http://wiki.hl7.org/index.php?title=Open_Source_FHIR_implementations |archivedate=2014-12-20

}}

A variety of applications were demonstrated at the FHIR Applications Roundtable in July 2016.{{Cite web|url=http://www.healthcare-informatics.com/blogs/david-raths/mix-applications-showcase-demonstrate-fhir-s-potential|title=Mix of Applications at Showcase to Demonstrate FHIR’s Potential {{!}} David Raths {{!}} Healthcare Blogs|website=www.healthcare-informatics.com|access-date=2016-09-13}} The Sync for Science (S4S) profile builds on FHIR to help medical research studies ask for (and if approved by the patient, receive) patient-level electronic health record data.{{Cite web|url=http://www.healthcareitnews.com/news/precision-medicine-analytics-data-science-and-ehrs-new-age|title=Precision medicine: Analytics, data science and EHRs in the new age|date=2016-08-15|access-date=2016-09-13}}

In January, 2018, Apple announced that its iPhone Health App would allow viewing a user's FHIR-compliant medical records when providers choose to make them available. Johns Hopkins Medicine, Cedars-Sinai, Penn Medicine, NYU-Langone Medical Center, Dignity Health and other large hospital systems participated at launch.{{Cite news|url=https://www.apple.com/newsroom/2018/01/apple-announces-effortless-solution-bringing-health-records-to-iPhone/|title=Apple announces solution bringing health records to iPhone|work=Apple Newsroom|access-date=2018-08-09|language=en-US}}

Also in 2018, Google started using FHIR as the basis for its machine learning applications. {{Cite web|url=https://ai.googleblog.com/2018/03/making-healthcare-data-work-better-with.html|title=

Making Healthcare Data Work Better with Machine Learning|work=Google AI|date=2018-03-02|access-date=2021-02-15|language=en-US}}

In 2014, the U.S. Health IT Policy and the Health IT Standards committees endorsed recommendations for more public (open) APIs.

The U.S. JASON task force report on "A Robust Health Data Infrastructure" says that FHIR is currently the best candidate API approach, and that such APIs should be part of stage 3 of the "meaningful use" criteria of the U.S. Health Information Technology for Economic and Clinical Health Act.{{cite news | url=http://www.modernhealthcare.com/article/20141016/NEWS/310169945 | title=EHR interoperability solution offered by key IT panels | work=Modern Healthcare

| date=2014-10-16 | accessdate=2014-11-08 }}{{cite news | url=http://www.modernhealthcare.com/article/20141021/NEWS/310219945 | title=Proposed interoperability overhaul finds boosters, doubters | work=Modern Healthcare | date=2014-10-21 | accessdate=2014-11-08 }}{{cite news | url=http://www.healthcare-informatics.com/article/federal-hit-committees-ok-public-api-recommendations-onc | title=Federal HIT Committees OK Public API Recommendations to ONC | work=Healthcare Informatics | date=2014-10-15 | accessdate=2014-11-08 }}{{cite news | url=http://www.healthdatamanagement.com/news/Teams-Make-their-Pitch-for-Defense-EHR-Contract-49192-1.html | title=Teams Make their Pitch for Defense EHR Contract | work=Health Data Management | date=2014-11-07 | accessdate=2014-11-08 }}

In December 2014, a broad cross-section of US stakeholders committed to the Argonaut Project{{cite news

|url=http://www.hl7.org/documentcenter/public_temp_B669E2A2-1C23-BA17-0C7A999023268366/pressreleases/HL7_PRESS_20141204.pdf

|title=HL7 Launches Joint Argonaut Project to Advance FHIR

|work=HL7 International

|date=2014-12-04

|accessdate=2014-12-26

|url-status=dead

|archiveurl=https://web.archive.org/web/20141228100113/http://www.hl7.org/documentcenter/public_temp_B669E2A2-1C23-BA17-0C7A999023268366/pressreleases/HL7_PRESS_20141204.pdf

|archivedate=2014-12-28

}}

which will provide acceleration funding and political will to publish FHIR implementation guides and profiles for query/response interoperability and document retrieval by May 2015.{{cite news

| url=http://www.healthcareitnews.com/blog/kindling-fhir

| title=Kindling FHIR

| work=Healthcare IT News

| date=2014-12-04

| accessdate=2014-12-06 }}

It would then be possible for medical records systems to migrate from the current practice of exchanging complex Clinical Document Architecture (CDA) documents, and instead exchange sets of simpler, more modular and interoperable FHIR JSON objects.{{cite news

| url=http://www.informationweek.com/strategic-cio/can-argonaut-project-make-exchanging-health-data-easier/a/d-id/1318774

| title=Can Argonaut Project Make Exchanging Health Data Easier?

| work=InformationWeek

| date=2015-01-26

| accessdate=2015-02-28 }}

The initial goal was to specify two FHIR profiles that are relevant to the Meaningful Use requirements, along with an implementation guide for using OAuth 2.0 for authentication.

{{cite news

| url=http://www.healthcare-informatics.com/article/halamka-expect-argonaut-deliverables-may

| title=Halamka: Expect Argonaut Deliverables by May

| work=healthcare-informatics.com

| date=2015-02-19

| accessdate=2015-02-28 }}

A collaboration agreement with Healthcare Services Platform Consortium (now called Logica) was announced in 2017.{{Cite web|url=https://www.healthcare-informatics.com/news-item/interoperability/hl7-teams-healthcare-services-platform-consortium-fhir-development|title=HL7 Teams with Healthcare Services Platform Consortium on FHIR Development {{!}} Healthcare Informatics Magazine {{!}} Health IT {{!}} Information Technology|website=www.healthcare-informatics.com|language=en|access-date=2017-03-30}} Experiences with developing medical applications using FHIR to link to existing electronic health record systems clarified some of the benefits and challenges of the approach, and with getting clinicians to use them.{{Cite web|url=https://www.healthcare-informatics.com/article/interoperability/slow-fhir-will-much-hyped-standard-turbo-charge-interoperability-or-maybe|title=Top Ten Tech Trends 2017: Slow FHIR: Will a Much-Hyped Standard Turbo-Charge Interoperability—Or Maybe Not Quite? {{!}} Healthcare Informatics Magazine {{!}} Health IT {{!}} Information Technology|website=www.healthcare-informatics.com|language=en|access-date=2017-03-30}}

The Da Vinci Project{{cite web

| url=https://www.hl7.org/about/davinci/

| title=DaVinci Project

| work=HL7 International

| accessdate=2021-02-15 }}

, a private-public initiative, was initiated in 2018, to tackle value-based care in which payers and providers are working toward the adoption of HL7 FHIR to connect stakeholders. They are developing FHIR specifications to support some of the most expensive fault lines in the healthcare system: gaps in care and information, identification of emerging member risk, and patient transitions between levels of care, especially in emergencies.

{{cite news

| url=https://www.forbes.com/sites/forbestechcouncil/2020/03/02/fhir-fever-is-catching-on-in-healthcare/

| title=FHIR Fever Is Catching On In Healthcare

| work=Forbes

| date=2021-03-02

| accessdate=2021-02-15 }}

In 2020, the U.S. Centers for Medicare & Medicaid Services (CMS) issued their Interoperability and Patient Access final rule, (based on the 21st Century Cures Act) requiring use of FHIR by a variety of CMS-regulated payers, including Medicare Advantage, organizations, state Medicaid programs, and qualified health plans in the Federally Facilitated Marketplace by 2021.{{Cite web|title=CMS Interoperability and Patient Access final rule {{!}} CMS|url=https://www.cms.gov/Regulations-and-Guidance/Guidance/Interoperability/index|access-date=2020-09-22|website=www.cms.gov}}

In 2020, the Brazilian Ministry of Health, by the IT Department of the SUS, started one of the world's largest platforms for national health interoperability, called the National Health Data Network, which uses HL7 FHIR r4 as a standard in all its information exchanges.{{Cite web|title=RNDS – Ministério da Saúde|url=https://rnds.saude.gov.br/|access-date=2020-11-10|language=pt-BR}}

{{reflist|30em}}

• [http://hl7.org/fhir/ FHIR Standard] (latest release)
• [https://web.archive.org/web/20141210035857/https://fhir.smartplatforms.org/#/ui/select-patient SMART FHIR Starter] demo of open source SMART-on-FHIR server (free registration)

{{Health informatics}}

:Category:Standards for electronic health records

:Category:Industry-specific XML-based standards

:Category:JSON