Where There’s Smoke… There’s FHIR

The old saying “Where there’s smoke there’s fire” is true for HL7’s newest draft standard: Fast Healthcare Interoperability Resources (FHIR). FHIR – pronounced “fire”– is climbing the Gartner Hype Curve and it’s time for governments and vendors to pay attention.

It’s been almost 2 years since we first published the article announcing the development of FHIR1. The key message at the time was “keep calm, carry on”. Two years later, our message is equally as simple, “keep calm, but pay attention”.

Perhaps the most significant reason you need to pay attention to FHIR is the fact that Epic, Cerner, and Siemens (to name a few) have formed a group called the Healthcare Services Platform Consortium (HSPC) that is “hitching its wagon” to FHIR2. These are major players in the US market and their products have global reach.

Why are these companies and many others backing FHIR? The answer to that question requires understanding what makes FHIR different from its predecessors. FHIR combines the best features of HL7’s Version 2, Version 3 and CDA® product lines while leveraging the latest web standards and applying a tight focus on the ability to easily implement it. In previous versions of HL7 standards the primary unit of information exchange was a message or a document. With FHIR, the primary unit of information exchange is a resource, which is a granular clinical concept such as a patient. To a certain extent, a resource is similar to an HL7 v2 segment or an HL7 v3 common message element type (CMET).

FHIR’s resources can be individually managed or combined into more complex constructs such as messages or documents. This flexibility allows developers to tackle different interoperability challenges with ‘right­size’ applications, ranging from large scale hospital information systems to mobile applications with a handful of basic functions.

Another attractive feature of FHIR is that each resource only contains the minimum information that working group members agree is required to express the clinical concept. By comparison, HL7 v3 followed the “design by constraint” methodology whereby HL7 working groups had to define all the information possibly required for specific transactions, and then implementers were expected to remove (where permissible) the content that wasn’t pertinent to their implementation. FHIR’s focus on only the minimum amount of information has accelerated its progression towards becoming a standard and made it is easier for developers to quickly produce applications. Unlike previous HL7 standards, FHIR offers options for interoperability out-of-the-box focusing on base resources that can be used as is, or can also be adapted for jurisdictional requirements.

FHIR resources can be expressed in both XML and JSON, both of which are supported by developers globally. There is also an abundance of tools to help application developers. For example, there are several FHIR servers available 24/7 for people to test their applications against. University Health Network even has its own publicly available FHIR server called HAPI FHIR3. The Office of the National Coordinator (ONC) funded the creation of SMART on FHIR which provides developers with a complete platform to create standards-based applications, covering everything from the data-layer to security. Finally, developers from around the world have tested their applications at FHIR connectathons held in conjunction with HL7 working group meetings for two years now. The last connectathon included 62 vendor participants – double that of the previous year.

For provinces and jurisdictions who have invested in other standards such as HL7v2, v3 and CDA, FHIR can be integrated into a blended EHR solution (e.g. inter-provincial exchange of key information, front-end access to data captured via existing messaging and document paradigms, etc.) or used in emerging areas such as mobile applications, appointments and scheduling or Personal Health Record solutions.

For vendors, FHIR offers resources that are significantly more portable across implementations than other exchange standards thereby reducing effort and costs and encouraging faster adoption.

FHIR is currently a Draft Standard for Trial Use and is about 1-2 years away from being a stable, normative standard. So where is FHIR in the Gartner hype curve? It’s safe to say FHIR is moving out of the Technology Trigger stage – characterized by early proof of concepts but not necessarily commercially viable products – and moving towards the peak of Inflated Expectations with a dramatic rise of early adopters over the next 1-2 years. It’s time to start paying attention.

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