Catching FHIR: Healthcare Interoperability in 2023
At this point, it is clear that there’s a slow but steady march in healthcare toward interoperability.
There were two milestones in the last quarter of 2022. In October, the 21st Century CURES Actopened medical records up to patients. Then all U.S. healthcare providers are supposed to follow FHIR standards (Fast Healthcare Information Resources) as part ofONC’s mandate to promote interoperability in healthcare by January 1st, 2023.
In the past few years, interoperability in healthcare has gone from a best practice to a mandate. Countries such as the US, Canada, and the UK have used FHIR extensively as a healthcare data standard framework.
With the increasing influence of FHIR standards in 2023, we will center our discussion around why this data standard matters, how it differs from previous standards, and how it is well-positioned to facilitate healthcare interoperability in a digital era.
The Pursuit of Interoperability in a Sea of Software
To understand FHIR, you need to understand the problem it tries to solve.
In 2011, investor Marc Andreessen said, “Software is eating the world.” In healthcare, this move has occurred “gradually, then suddenly” as the pandemic brought a six-year acceleration in digital transformation.
As a result, a sea of software — electronic medical and health records (EMR / EHR), revenue cycle management systems, patient portals, and virtual care — inundates today’s healthcare industry. Take EHR as an example. A study found that the average US health system had up to 18 EMR systems in place when including affiliated providers.
Unfortunately, most of these systems don’t “talk” to each other, leaving data in silos. Manual healthcare information coordination becomes a cumbersome ordeal even within the same health system. Eight out of 10 US hospitals still send medical records via fax. Better interoperability could save a healthcare organization nearly $1.6 million in three years by cutting data coordination time by half. More accessible data will allow the industry to better coordinate care and, ultimately, save more lives.
What Is FHIR?
FHIR is the latest global data standard from HL7 International. Published in 2014, it aims to use web-centric technology to break down barriers to healthcare data exchange.
Think about the internet: FHIR is based on the same concept to facilitate health data exchange. Just as any internet user can access the same URL from different browsers, FHIR enables authorized users to access the same data from different systems.
There are four primary components in FHIR’s core design:
- Application programming interface (API)
FHIR uses a RESTful API for health data exchange in various settings. RESTful APIs, as the backbone of many current web services, provide a developer-friendly way to share healthcare data.
As the building blocks for FHIR, Resources are information packets that can represent various clinical decisions and administrative use cases. For example, if a patient gets a flu shot, the healthcare provider will update that particular FHIR resource for immunization in the patient’s file immediately. Anyone can access the FHIR Resource Index to learn more about the possibilities they provide.
FHIR Profiles provide richer content and data to define the use of resources in specific circumstances to fit your needs more precisely.
FHIR References show how to connect different resources into meaningful use cases. For example, by linking the resources “Patient,” “Condition,” and “Prescription,” you can customize to specific scenarios.
How does FHIR Differ from Previous ones?
One of the primary healthcare interoperability woes is unstructured health data (that is, images, faxes, handwritten notes, and PDFs), accounting for 80% of today’s healthcare data.
Before using FHIR, health data transfers occurred via fax or XML-based continuity-of-care documents - both relied on nonstandardized, time-consuming manual processes. Previous standards, including HL7 v2, HL7 v3, and CDA, unfortunately, could not work with unstructured data. What makes FHIR standards gain wider adoption is that it allows a streamlined exchange of unstructured health data. Besides, FHIR brings the following benefits to healthcare organizations:
- It is simple. FHIR APIs and Resources allow every developer to build apps faster and easier. FHIR supports common standards like JSON, XML, HTTP, and OAuth, so it lowers the learning curve for people who do not have a healthcare background.
- FHIR is universal and builds reusable knowledge bases for multiple applications, drastically cutting the app development burden. Various FHIR users can use a newly written application.
- FHIR is flexible. FHIR Resources and Profiles enable users to configure them into a wide range of customized use cases. Thanks to such pluggable solutions, developing a healthcare interoperability interface now takes hours instead of days or weeks.
- It is dynamic. Deployment of changes and updates occurs without damaging existing implementations.
- FHIR is open-source. As a search API, the FHIR specification is free to access by anyone who wants to develop an app.
- And FHIR is not just for health data. It can also capture administrative data to help bridge the gap between payers’ and providers’ needs.
How Will FHIR Transform Healthcare in a Digital Era?
At a high level, FHIR enables a holistic view of patient data for more effective care coordination and better patient outcomes. Every authorized member of a patient’s care team — doctors, pharmacists, insurers, and the patient — can securely access a unified record of care and patient-generated health data. Therefore, FHIR can maximize the value of healthcare information for more-informed clinical decisions to facilitate value-based care at scale.
For healthcare organizations, FHIR lowers the barrier to entry and enables faster software innovation. For example, developers without previous healthcare IT experience can rely on common tools and protocols, various free online tools, and open-source libraries. FHIR will effectively save time and costs of developing customized apps that can share data reliably with all sources.
For individual physicians, FHIR empowers them to make faster, more informed clinical decisions. It also helps eliminate time-consuming tasks such as processing patient intake data and transmitting patient records, enhancing operational efficiency. Less manual handling of patient data can also reduce its exposure to security threats.
At last, patients can have better visibility into and control over their healthcare data, enabling them to make better choices for their own health. In addition, during an emergency, when patients fall too ill to answer questions about allergies or medications, a comprehensive, accurate view of their medical history could have a life-critical impact.
This list of potential benefits of FHIR goes on. And benefits on each level will propagate throughout the system to make healthcare more open, effective, and secure in a digital-first future.
The pandemic revealed the gaps in healthcare interoperability. However, it also raised awareness across all levels that better healthcare data sharing will increase our resilience in the next crisis.
Across the globe, we’ve seen governments, healthcare software vendors, providers, and payers embracing FHIR as a global standard for securely sharing healthcare data. Apple, Google, Microsoft, and most EHR vendors, including Epic and Cerner, support FHIR. Plus, there are already about 2 million FHIR applications.
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