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

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.

[1]  Reinhold Haux,et al.  An HL7-FHIR-based Object Model for a Home-Centered Data Warehouse for Ambient Assisted Living Environments , 2015, MedInfo.

[2]  Adolfo Muñoz Carrero.  Norma UNE-EN ISO 12967 Health Informatics - Service Architecture (HISA) , 2013 .

[3]  R. Sallis,et al.  Developing healthcare systems to support exercise: exercise as the fifth vital sign , 2011, British Journal of Sports Medicine.

[4]  D. Moher,et al.  Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement , 2009, BMJ : British Medical Journal.

[5]  Jane Baronas,et al.  A FHIR Human Leukocyte Antigen (HLA) Interface for Platelet Transfusion Support , 2017, Applied Clinical Informatics.

[6]  Kui Wang,et al.  Visual FHIR: An Interactive Browser to Navigate HL7 FHIR Specification , 2017, 2017 IEEE International Conference on Healthcare Informatics (ICHI).

[7]  Heinz U. Lemke,et al.  Accessing Patient Information for Probabilistic Patient Models Using Existing Standards , 2016, eHealth.

[8]  Sofiène Tahar,et al.  Formal reliability analysis of a typical FHIR standard based e-Health system using PRISM , 2014, 2014 IEEE 16th International Conference on e-Health Networking, Applications and Services (Healthcom).

[9]  Dean F. Sittig,et al.  How the continuity of care document can advance medical research and public health. , 2012, American journal of public health.

[10]  L. V. Pieterson,et al.  Smart textiles: Challenges and opportunities , 2012 .

[11]  Reza Samavi,et al.  COC: An Ontology for Capturing Semantics of Circle of Care , 2015, EUSPN/ICTH.

[12]  Christel Daniel-Le Bozec,et al.  Cross border semantic interoperability for clinical research: the EHR4CR semantic resources and services , 2016, CRI.

[13]  Hannes Ulrich,et al.  Metadata Repository for Improved Data Sharing and Reuse Based on HL7 FHIR , 2016, MIE.

[14]  Diego Boscá,et al.  Combining Archetypes with Fast Health Interoperability Resources in Future-proof Health Information Systems , 2015, MIE.

[15]  Pascal B. Pfiffner,et al.  C3-PRO: Connecting ResearchKit to the Health System Using i2b2 and FHIR , 2016, PloS one.

[16]  Gil Alterovitz,et al.  SMART precision cancer medicine: a FHIR-based app to provide genomic information at the point of care , 2016, J. Am. Medical Informatics Assoc..

[17]  Steven A. Demurjian,et al.  Achieving RBAC on RESTful APIs for Mobile Apps Using FHIR , 2017, 2017 5th IEEE International Conference on Mobile Cloud Computing, Services, and Engineering (MobileCloud).

[18]  Jimeng Sun,et al.  Clinical Predictive Modeling Development and Deployment through FHIR Web Services , 2015, AMIA.

[19]  David Robert Posircaru,et al.  Integrating legacy medical applications in a standardized Electronic Health Record platform , 2015, 2015 E-Health and Bioengineering Conference (EHB).

[20]  K. Sikorska-Siudek,et al.  AB0280 Mobile Application for Patients with Rheumatoid Arthritis (RA) as a Supporting Tool for Disease Activity Monitoring: Its Usability and Interoperability , 2015 .

[21]  J Michael McCoy,et al.  The SMART Platform: early experience enabling substitutable applications for electronic health records , 2012, J. Am. Medical Informatics Assoc..

[22]  Eric Zapletal,et al.  A Fast Healthcare Interoperability Resources (FHIR) layer implemented over i2b2 , 2017, BMC Medical Informatics and Decision Making.

[23]  Harry Hochheiser,et al.  An information model for computable cancer phenotypes , 2016, BMC Medical Informatics and Decision Making.

[24]  J. J. Lau,et al.  Standard Information Models for Representing Adverse Sensitivity Information in Clinical Documents , 2016, Methods of Information in Medicine.

[25]  Mie V. Andersen,et al.  Feasibility of Representing a Danish Microbiology Model Using FHIR. , 2017, Studies in health technology and informatics.

[26]  Georg Duftschmid,et al.  Bridging the Gap between HL7 CDA and HL7 FHIR: A JSON Based Mapping , 2016, eHealth.

[27]  David A. Clunie,et al.  Technical Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper , 2016, Journal of Digital Imaging.

[28]  Peter Morris,et al.  Interconnected Personal Health Record Ecosystem Using IoT Cloud Platform and HL7 FHIR , 2017, 2017 IEEE International Conference on Healthcare Informatics (ICHI).

[29]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement , 2009, BMJ : British Medical Journal.

[30]  Ahmad A. Alhamed,et al.  A Middleware to Support HL7 Standards for the Integration between Healthcare Applications , 2015, 2015 International Conference on Healthcare Informatics.

[31]  May D. Wang,et al.  Intelligent mortality reporting with FHIR , 2017, 2017 IEEE EMBS International Conference on Biomedical & Health Informatics (BHI).

[32]  Michael Lawley,et al.  Towards achieving semantic interoperability of clinical study data with FHIR , 2017, Journal of Biomedical Semantics.

[33]  Kensaku Kawamoto,et al.  Viewpoint Paper: The Clinical Document Architecture and the Continuity of Care Record: A Critical Analysis , 2006, J. Am. Medical Informatics Assoc..

[34]  Jie Xu,et al.  Developing a data element repository to support EHR-driven phenotype algorithm authoring and execution , 2016, J. Biomed. Informatics.

[35]  Matthew Bishop,et al.  Considerations for Exchanging and Sharing Medical Images for Improved Collaboration and Patient Care: HIMSS-SIIM Collaborative White Paper , 2016, Journal of Digital Imaging.

[36]  Paul G. Biondich,et al.  Enabling Better Interoperability for HealthCare: Lessons in Developing a Standards Based Application Programing Interface for Electronic Medical Record Systems , 2015, Journal of Medical Systems.

[37]  Tim Benson,et al.  Principles of Health Interoperability , 2016, Health Information Technology Standards.

[38]  Paolo Marcheschi,et al.  Relevance of eHealth standards for big data interoperability in radiology and beyond , 2017, La radiologia medica.

[39]  S. V. R. Anand,et al.  CyPhyS+: A Reliable and Managed Cyber-Physical System for Old-Age Home Healthcare over a 6LoWPAN Using Wearable Motes , 2015, 2015 IEEE International Conference on Services Computing.

[40]  Stefan Schulz,et al.  HL7 FHIR: Ontological Reinterpretation of Medication Resources. , 2017, Studies in health technology and informatics.

[41]  Dean F Sittig,et al.  The promise of the CCD: challenges and opportunity for quality improvement and population health. , 2011, AMIA ... Annual Symposium proceedings. AMIA Symposium.

[42]  Tomasz Kocejko,et al.  The data exchange between smart glasses and healthcare information systems using the HL7 FHIR standard , 2016, 2016 9th International Conference on Human System Interactions (HSI).

[43]  Alexander Mense,et al.  Biosignals, Standards and FHIR - The Way to Go? , 2017, eHealth.

[44]  Joshua C. Mandel,et al.  Opening the Duke electronic health record to apps: Implementing SMART on FHIR , 2017, Int. J. Medical Informatics.

[45]  Giuseppe De Pietro,et al.  Fuzzy on FHIR: a Decision Support service for Healthcare Applications , 2016, 3PGCIC.

[46]  Syed Ali Raza,et al.  Healthcare Data Validation and Conformance Testing Approach Using Rule-Based Reasoning , 2015, HIS.

[47]  Kavishwar B. Wagholikar,et al.  SMART-on-FHIR implemented over i2b2 , 2017, J. Am. Medical Informatics Assoc..

[48]  Wei Li,et al.  Design and implementation of integration architecture of ISO 11073 DIM with FHIR resources using CoAP , 2017, 2017 International Conference on Information and Communications (ICIC).

[49]  Dimitra I. Kaklamani,et al.  Using FHIR to develop a healthcare mobile application , 2014 .

[50]  Catherine E. Chronaki,et al.  Towards mHealth Assessment Guidelines for interoperability: HL7 FHIR , 2016, pHealth.

[51]  Kenneth D. Mandl,et al.  SMART on FHIR: a standards-based, interoperable apps platform for electronic health records , 2016, J. Am. Medical Informatics Assoc..

[52]  Mark L. Braunstein.  Patient — Physician collaboration on FHIR (Fast Healthcare Interoperability Resources) , 2015, 2015 International Conference on Collaboration Technologies and Systems (CTS).

[53]  Andreas Schuler,et al.  Applying FHIR in an Integrated Health Monitoring System , 2015 .

[54]  Stanley M. Huff,et al.  Profiling Fast Healthcare Interoperability Resources (FHIR) of Family Health History based on the Clinical Element Models , 2016, AMIA.

[55]  Ioanna Chouvarda,et al.  A reusable ontology for primitive and complex HL7 FHIR data types , 2015, 2015 37th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC).

[56]  Christopher Doss,et al.  Lighting the Mobile Information FHIR: How FHIRframe Could Dramatically Improve Mobile Health and Change HIM in the Process , 2015 .