The HL7 FHIR Standard - Explained

With the advancement of technology, it’s no secret, healthcare organizations are undergoing a fundamental transformation in how they incorporate tech. This shift is motivated by an ambition for improved workflows and patient privacy as well as new capabilities empowered through integration, which has been further encouraged by government regulations. By far the most incendiary change we have seen is the all-encompassing digitization of medical records and interconnectivity among different systems. 

An integral part of this change is HL7’s newest standard known as Fast Healthcare Interoperability Resources or HL7 FHIR, pronounced HL7 “fire”.  This system provides a common language for healthcare data exchange and allows for the organization of information into a hierarchical coding structure. 

What are HL7 FHIR Standards?

HL7 FHIR standards enables medical organizations to easily store, retrieve, update and share patient data in an efficient and secure manner while also ensuring interoperability between different systems. HL7 FHIR is thus essential in providing better management of patient records within a digital environment. It serves as the foundation on which many healthcare infrastructure improvements are built upon, such as in artificial intelligence applications like machine learning that rely heavily on comprehensive datasets provided by HL7 FHIR. Ultimately, HL7 FHIR's hierarchical coding structure helps medical organizations manage data and patient privacy in a secure and structured way.  

The goal of the FHIR data model, according to HL7, is to help ease the challenges of data sharing and interoperability by “...simplify[ing] implementation without sacrificing information integrity.It leverages existing logical and theoretical models to provide a consistent, easy to implement, and rigorous mechanism for exchanging data between healthcare applications.”

The Need for HL7 FHIR Functionality

Historically, patient records were siloed in the practitioner’s office, due to paper-based documentation. The fax machine changed how patient data could be shared, but as new forms of communication came online, they were often not viable solutions due to different regulations and standards, e.g. HIPAA.

With the emergence of electronic health record systems (EHRs), direct system-to-system secure digital transfer and portability of patient records become possible. Yet, even as we get close to ushering out 2023 we’ve still seen data formatting and availability as the wild, wild west. Each system implementer provides different ways to share data, or in some cases, prevent the sharing of data.

Since there had been no mandated universal standard for data exchange, each EHR had its own data specifications – often a hybrid approach using some industry standards and their own custom formats. This format and integration fragmentation put a lot of pressure on vendor integration teams and required custom API implementations for each platform they wished to integrate with. Because every implementation required a time and monetary investment, this meant that the APIs intended to provide data portability, ironically became hurdles for larger integration strategies.

History of HL7 and the FHIR Data Model

In 1987, Health Level Seven International’s (HL7) formed as a non-profit to help define data portability within the Industry. Over time, HL7 became a leader in defining standards for data sharing and interoperability. Since HL7’s founding, they have provided a variety of data portability formats and standards. These formats have evolved over the years to meet the needs of data providers and consumers, with varying success and often limitations.

The initial HL7 v2 & 3 message formats were great starts in data interoperability but have proved to be either too unstructured or too limited in scope to be useful for all clinical applications. To work around these limitations, many EHR vendors created their own data formats and Application Programming Interface (API) standards to enable data sharing.

The newest release of FHIR HL7 (version 4.0) is the first normative release of the FHIR standard. This is a huge milestone for FHIR HL7 and future data interoperability because any future changes to the specification need to be backward compatible with the base normative version. This helps guarantee vendors that their implementations will not deteriorate over time or require rewriting as new versions of the Fast Healthcare Interoperability Resources format are released.

HL7 FHIR and CMS

Along with the first normative release of the FHIR standard to the American National Standards Institute (ANSI) for certification, CMS has announced in their “Interoperability and Patient Access final rule” that “HHS has finalized the technical standards in the ONC’s 21st Century Cures Act final rule for payers and developers to use HL7 FHIR 4.0.1”.

The ONC’s 21st Century Cures Act final rule mandated that EHR vendors implement support for SMART on FHIR Core Capabilities. One of the most promising uses of SMART on FHIR is the ability to embed and launch apps from within the EHR itself. Apps can be developed by third party vendors and integrated seamlessly into the EHR allowing the apps access to data within the system in a standardized methodology by leveraging the FHIR standard. This access allows for extending the EHRs capabilities without having the EHR vendors implement the functionality themselves.

By having the ONC Cures Act Final Rule regulations define and require interoperability using the FHIR standard, we can expect a more unified and easier integration process across EHR applications and vendor systems over the next few years with HL7 FHIR. 

The Future of HL7 FHIR

The implementation of the HL7 FHIR standard by various organizations, vendors and healthcare platforms is a remarkable event that will bring tremendous opportunities for patients and providers. Its potential lies in its ability to securely and efficiently transmit patient data from one system to another, allowing for improved accuracy and speed of treatment. With HL7 FHIR, healthcare providers will be able to access patient records quickly and securely while also ensuring that data privacy and security are maintained. Additionally, HL7 FHIR has the potential to provide real-time clinical decision support, by providing access to relevant patient information when needed. 

At Foresee Medical, we have created a SMART on FHIR app for our HCC Risk Profiles, allowing providers to view our HCC Risk Analysis of the patient they are currently interacting with enabling real-time conversations and recommendations for their patients without having to leave the EHR window.

Blog by: The ForeSee Medical Team