Fast Health Interoperability Resources (FHIR): Current Status in the Healthcare System

Fast Health Interoperability Resources (FHIR): Current Status in the Healthcare System

Rishi Kanth Saripalle
Copyright: © 2019 |Pages: 18
DOI: 10.4018/IJEHMC.2019010105
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The inception of EHR has shown a lot of potentials and virtually eliminated the drawbacks of paper-based medical notes. However, the transition has not been seamless due to various technical and political drawbacks. One of the major technical challenges is interoperability. The biomedical community has established various structural and semantic standards to capture and share medical data across heterogeneous systems such as ASTM Community Care Record, Health Level 7 (HL7) Clinical Care Document, etc. The HL7 organization has recently published Fast Health Interoperability Resources (FHIR) – a standard to improve interoperability, overcome shortcomings of the previous standard and integrate lightweight web services. This article provides an overview of HL7 FHIR, its concepts and literature review on its current status, usage, and adoption. Based on the thorough research and literature review, the authors strongly believe that FHIR can bridge interoperability gap between the growing number of disparate and variety of healthcare entities.
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The idea and inception of Electronic Health Record (EHR) (Shortliffe & Cimino, 2006) has revolutionized the healthcare across the globe and its practice. In the past three decades, the development and adoption of EHR across healthcare organizations is fueled by exponential rise in computing, cheaper digital storage, computer networking, and support from government financial programs such as Health Information Technology (HITECH) Act (Blumenthal, 2010; Goldstein & Thorpe Jane, 2010). Capturing the patient data in an electronic format virtually eliminated all the drawbacks of paper-based format, and allowed the experts to the share the data across healthcare information systems (e.g., EHR, Ambulatory Care, Rehabilitation Centers, etc.). To realize EHR’s and its goals, the community (experts from domains such as healthcare, information systems and security, computer science, public health, public policy, etc.) has developed multiple structural and semantic standards to represent, share, and provide consistent semantic interpretation of the patient’s medical data. This article will be focusing on the structural standards used in United States. For example, ASTM Continuity Care Record (CCR) (Ferranti, Musser, Kawamoto, & Hammond, 2006), HL7 Continuity Care Document (CCD) (D'Amore, Sittig, & Ness, 2012; D’Amore, Sittig, Wright, Iyengar, & Ness, 2011), HL7 Clinical Document Architecture (CDA) (Boone, 2011), and HL7 Reference Information Model (RIM) are some of the most prominent standards. Briefly, ASTM CCR is a collaborative effort between ASTM, Massachusetts Medical Society, and other healthcare organizations to capture patient health summary (e.g., problems, medications, allergies, care plan, etc.) and the current status. Health Level 7 (HL7) CCD was developed by HL7 in consultation with ASTM to combine the benefits of ASTM CCR and the HL7 CDA. The HL7 CDA is an XML-based standard intended to specify both the structure and semantics of the patient’s data as a clinical document for exchange. The CDA documents can be exchanged using HL7 V2 or V3 messages (Boone, 2011), health exchange protocols such as XDS, HTTP, etc. Both HL7 V2 and HL7 V3 messaging standards support hospital workflows, but the HL7 V3 is based on formal methodology, modeling, and object-oriented principles. The HL7 RIM is the cornerstone of the HL7 V3 messaging design and development. Experts combine HL7 RIM, semantic terminology or ontological standards, and model-driven principles to analysis and design consensus-based standards for healthcare information system interoperability (Benson & Grieve, 2016). Apart from these standards, Europe has also defined multiple healthcare standards. Health informatics - Electronic Health Record Communication (EN 13606) (ISO, 2008) standard defines rigorous and stable information architecture for communicating part or all of the EHR with other systems. Health Informatics Service Architecture (HISA) (ISO, 2009) standard is based on service-oriented architecture (SOA) that provides guidance on the development of modular open information systems. openEHR (Heard & Beale, 2007) – an open source EHR specification and implementation that is based on the concept of archetypes.

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