FHIR, pronounced Fire, is a free, vendor-agnostic data-sharing standard developed by Health Level Seven International (HL7). FHIR combines the most practical features from previous standards with a fresh internet-based approach to enhance interoperability and ease data exchanges across the dynamic healthcare ecosystem.

It is an implementation-focused set of standard APIs based on RESTful principles that allow new applications and legacy systems to more easily share information than in the past. FHIR has been embraced by many health systems, some of the most prominent electronic health record (EHR) vendors, and digital health organizations implementing innovative technologies and solutions that support a wide range of healthcare needs.

A few of the most notable organizations utilizing FHIR include Boston Children's Hospital, Duke Medicine, Healthcare Corporation of America, Epic, Cerner, Allscripts, Apple, and our team at Health Gorilla.

According to Prolifics, ​​HL7 has cited the following benefits of FHIR for the healthcare ecosystem:

• FHIR simplifies implementation
• FHIR reduces the level of entry for developers
• FHIR is accessible free of charge
• FHIR comes with off-the-shelf interoperability
• FHIR's flexibility allows base resources to be used as-is and is adaptable as needed
  

Below we detail the components of FHIR, discuss the impact it's had on the healthcare industry, and highlight how Health Gorilla has leveraged FHIR based APIs to create our industry leading interoperability solutions. 

What are the Components of FHIR?

FHIR is made up of three primary components; resources, references, and profiles. Its core purpose is to supply a standard set of data elements, referred to as resources, which, when combined through references, cover most clinical use cases. Edge case scenarios are accounted for through an extension mechanism called profiling.  

Resources:

Resources are segments of information used to send, receive, or store data and satisfy most use cases. They can be represented in various formats, including UML, XML, JSON, or normal text with explanations. There are four segments of resources used in FHIR. These include metadata, narratives, extensions, and elements.

References:

References in FHIR are used to link FHIR resources together. References are typically provided as URLs, with an explicit identifier, or through text descriptions. For example, the resource "observation" could include a subject field of "reference type," which can be used to connect to a patient resource as the topic of the observation.

Profiles:

Profiles are used to define the use of a resource during specific circumstances. Profiles are written by developers and published in implementation guides which FHIR then standardizes. They are created and included in implementation guides to increase FHIRs ease of use and remove some of the technical aspects of implementation.

What is Smart on FHIR

SMART, an open-source, standards-based set of APIs that leverages the OAuth 2.0 standard, provides secure, universal access to EHRs.

In 2013 SMART acknowledged the traction that FHIR was gaining and decided to partner with their team rather than pursuing their framework. They quickly began developing tools and guidelines for the development community producing FHIR-based applications and provided infrastructure and security measures that FHIR had not had before.

Pairing SMART’s open-source capabilities with FHIR's data-sharing standards has enabled the healthcare development community to create applications that are suitable for the entire healthcare ecosystem.

Today SMART on FHIR provides two primary services, a framework for building FHIR-based applications and a platform to publish and access FHIR apps. SMART also developed an authentication mechanism using OAuth to approve third-party applications' access to EHR data and implemented OpenID Connect to ensure a safe sign-in to those apps.

There have been a variety of popular FHIR programs built using SMART on FHIR platform, including Apple's Health app and Microsoft Azure FHIR API.

The Benefits of FHIR for the Healthcare Community

Benefits for providers

FHIR enables providers to quickly access important clinical information, including electronic health records (EHR), administrative data, claims data, and more, allowing them to make educated and expedited treatment decisions. It also facilitates better coordination with payers, which has become essential with the healthcare industry transitioning to a value-based reimbursement model. Increasing cooperation between providers, payers, and individuals has multiple benefits, including better care coordination, prevention, and condition management, while simultaneously capping costs.

Benefits for developers

FHIR was created to simplify the implementation activities for developers, allowing them to focus on their product's true value. It is available at no cost, utilizes well-known web standards, like XML and JSON, and has out-of-the-box interoperability features. Developers also have access to HL7's thorough documentation, tools from FHIR's extensive community, and implementation libraries, allowing them to kick-start and scale their development.

Benefits for patients

FHIR has the ability to truly empower patients. As discussed above, FHIR, and more specifically SMART on FHIR, has made it easier for developers to build applications that integrate with EHR systems, allowing providers and patients to quickly find an app that offers their ideal user experience. Allowing patients to use their preferred applications to access their clinical data allows them to take control of their health and make more informed decisions about their medical care. It will also drive patient engagement and keep them updated on their lab results, allergies, medications, procedures, and more.

How Health Gorilla Leverages FHIR

Our team at Health Gorilla was an early adopter of FHIR and has seen first-hand how impactful it can be when solving interoperability challenges. We provide a suite of enterprise-level FHIR-based clinical APIs and software solutions that power fundamental healthcare workflows and data exchange scenarios. Our FHIR-native data platform also offers substantial analytic capabilities compliant with FHIR R4 profiles to ensure scalable medical record retrieval.

One of the reasons we're so confident in FHIR and its ability to solve interoperability stems from our accomplished work in Puerto Rico. After a few years of developing a group of strategic partners in Puerto Rico, the Puerto Rico Department of Health decided to partner with us to create the first Puerto Rico HIE (PRHIE). Today, we act as the single-source provider of Health Information Exchange for the Puerto Rico Department of Health and operate as the HIN connecting payers, labs, providers, patients, and public health officials. The PRHIE now includes more than 880 care sites, 13,000 providers and connects more than 2.9 million patients, enabling patient medical record data to be shared securely and electronically.

Our services and clinical FHIR APIs were also recognized in May of 2020 in Duke University's Interoperability Report as the only clinical exchange portal that met functional and security requirements for public health departments. The report stated that Health Gorilla, who is a Member of CommonWell and an Implementer on Carequality, "provides query access to all acute care sites on both networks, and maintains its own set of services (MPI and RLS) and capabilities (event notifications) that could increase utility for public health.

What's Next for Health Gorilla?

Early this year, Health Gorilla will be applying to become one of the first designated Qualified Health Information Networks (QHINs) under the Trusted Exchange Framework and Common Agreement (TEFCA).

Our team at Health gorilla have been active stakeholders as the Trusted Exchange Framework and Common Agreement were developed and have strongly advocated that FHIR be included as an alternative standard for message delivery. Our team agrees that a reliable message delivery system is critical to the success of TEFCA and believe that excluding FHIR from the framework will disrupt the digital innovation that has taken place.

We are looking forward to reviewing the final version of these new regulations and are very excited to expand our services as a Qualified Health Information Network.