As health care organizations strive for greater interoperability, the industry is poised to make a quantum leap with the introduction of HL7’s next generation standard, Fast Healthcare Interoperability Resources (FHIR). Pronounced “fire,” this robust health care data sharing standard fits many architectures and aims to broaden the scope of data sharing and help organizations exchange more granular, focused and timely information. Those entities that embrace FHIR will ultimately be able to communicate up-to-the minute data across disparate systems, fostering greater collaboration along the care continuum.

What makes FHIR different?
FHIR builds on existing HL7 interoperability standards, including the Version 2, Clinical Document Architecture (CDA) and Consolidated Clinical Document Architecture (C-CDA) standards. While the new interoperability standard includes both the messaging and document paradigms found in previous versions, it has a much more flexible architecture, allowing organizations to exchange more meaningful and targeted information across a variety of architectures, such as REST or SOA. For example, instead of only sharing messages or finite documents, such as the continuity of care document (CCD), FHIR allows users to interact with clinical data — searching, reading and updating it as well as sharing it with outside entities. Because of this flexibility and scalability, FHIR has the potential to chip away at interoperability barriers more than any other interoperability standard to date. 

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A key benefit to FHIR is that it breaks down data into finite, clinically and administratively relevant domains —called resources — which are logical data groupings that do not require further context to be understood. For instance, a patient’s allergies could be one resource and a patient’s test results might be another. By parsing data in this way, FHIR allows a user to search for, view, update and share single resources or groups of resources that fit together and paint a larger picture. Consider the example of a hospitalist who is preparing to perform a procedure. He or she can use FHIR-enabled technology to gather specific pieces of information from the patient’s primary doctor, such as the patient’s allergies, recent test results and family history — receiving only the data needed, in the specific timeframe 

Facilitating information sharing at this level represents a significant departure from previous standards, which do not let providers tailor the data they receive. For instance, while a CCD document might include the necessary information, it would also house significantly more data than the provider requires. In addition, the CCD would only include data from a fixed point in time — whenever the document was created. Depending on the timing, the data could be out-of-date. FHIR, on the other hand, pulls the most up-to-the-minute information, ensuring providers make care decisions on the most relevant and real-time data.

Being able to easily retrieve detailed and current information from a variety of sources will be especially important as organizations continue to increase their reliance on mobile technology to share data. When leveraging cell phones and tablets, it is critical for providers to be able to exchange just the data needed at a particular moment to prevent information overload and cumbersome navigation. With FHIR-enabled technology, a provider can review only that information needed at the time, allowing organizations to optimize mobile technology to further enhance and streamline interoperability.

Another benefit of FHIR is it is relatively straightforward to use. The interoperability standard employs the industry standard, web-based REST infrastructure developed with implementation in mind, so it can be operational right out of the box. Not only does this permit better testing and refinement, it should support greater adoption long term, increasing interoperability between organizations more rapidly and on a larger scale.

Taking the next step
Despite FHIR’s many advantages, it will not replace existing interoperability standards immediately. For the foreseeable future, organizations will most likely use the new data architecture in parallel with previous versions. It stands to reason that as organizations look to replace and upgrade their information systems, FHIR will become more prevalent.

[See also: FHIR and the future of interoperability.]

While regular FHIR use is a ways off, there is an opportunity now to get involved in shaping the new standards and engaging in preliminary tests. Currently, FHIR is in its first Draft Standard of Trials Use (DSTU) period, meaning organizations can access a version of FHIR immediately, keeping in mind the interoperability standard is still evolving. To get more familiar with FHIR, health care entities should consider attending one of HL7’s FHIR Connectathons, where industry leaders come together and test the new standard, engaging in preliminary data exchange. These interactive sessions help organizations see firsthand how FHIR enables more dynamic information sharing. They also serve as opportunities to network with colleagues seeking to improve interoperability. Most importantly, they give clinicians and developers the opportunity to weigh in on the new architecture, ensuring that the interoperability standard is as strong and effective as possible.

While it may seem daunting to test out a new interoperability standard, getting involved at this level does not have to be challenging. Since FHIR is based on lessons learned from HL7 and is more user-friendly than previous versions, organizations should be able to get up to speed fairly quickly, testing the interoperability standard on a small scale first and then increasing the usage complexity over time.

Ultimately, organizations need to “play” with FHIR. This standard is not something that is going to happen “to” the industry, it is something organizations of all sizes can shape and develop. As with many new standards, the interoperability standard will continue to evolve in years to come, and organizations on the forefront of this effort will directly contribute to the industry’s success in effectively sharing information across the continuum.

Viet Nguyen, MD, is a board certified clinical informaticist and chief medical information officer for Systems Made Simple, a Lockheed Martin company.