Although “interoperability” is not a word used in the medical field, it is now becoming more important in the field of healthcare. It has been a hot subject at least since the 1980s, when the increasing number of health IT systems began generating problems about how we are going to communicate information not just across hospitals and laboratories, but also between various departments in the same clinic.
Since then, a great number of standards for the exchange of data have been developed, some of which (like CDA) are still in use today. However, in the year 2021, there will be even more prerequisites. As a result of the proliferation of telehealth, the Internet of Medical Things, and the hundreds of healthcare devices and apps currently available on the market, both clinicians and patients have recognized the need for an approach that is both simple and up to date to facilitate the exchange of newly accessible health data.
Therefore, in the year 2020, the Centers for Medicare and Medicaid Services (CMS) of the United States published the final health IT interoperability standards. These rules require all CMS-regulated payers to adopt a new standard and achieve the highest possible level of clinical interoperability. Here is all you need to know about FHIR implementing whether you’re a healthcare practitioner, a developer of healthcare applications, or simply a patient with an interest in the topic.
WHAT IS FHIR, AND HOW EXACTLY WILL IT AFFECT MEDICAL CARE?
A standard for the sharing of healthcare data called FHIR (short for “Fast Healthcare Interoperability Resources”) was developed with the goal of fostering clinical interoperability. HL7, which is a standards-producing body positioned at the beginnings of interoperability, released FHIR in 2014, which is pronounced: “fire.”
APIs, or application programming interfaces, are bits of code that enable data transfer. FHIR provides a standard set of APIs so that healthcare systems may interact with one another. The usage of the FHIR specifications is not restricted in any way, and they make use of technologies and online standards that are typical in many other fields, particularly the REST architectural style of API. Developers have the ability to target certain clinical use cases by combining distinct FHIR components, which are referred to as resources. Alternatively, they may construct extensions based on the basic requirements. In the next paragraph, we will go into more depth on how it operates.
Therefore, FHIR represents our greatest opportunity to realize seamless data interchange. But what exactly does this entail in terms of day-to-day operations for each of the parties involved?
FHIR for the providers of medical care. Your EHR will have a much easier time connecting to third-party apps because to the seamless conduit that FHIR enables. You are not, in a general sense, restricted to using just your particular system and the integrations that it offers. You may also launch your own applications by outsourcing the development to a third-party vendor; thanks to FHIR standards, this process will be less time-consuming and costly. In addition to this, FHIR guarantees that the data will always be kept in a standardized fashion across all of its sources.
FHIR for software developers working in the healthcare industry. Instead of focusing on the technology, developers are free to concentrate on the value their solutions deliver. Programmers are able to construct applications fast and easily even if they are not acquainted with the healthcare domain because HL7 offers clear and extensive documentation, the community distributes a large number of free tools and assistance, and the ability to leverage popular web standards such as XML, JSON, HTTP, and OAuth. All of these factors contribute to HL7’s success.
The FHIR platform for patients. Patients are provided with a comprehensive overview of all of their clinical data through FHIR. The Apple Health app for iOS is a useful illustration of this point. It produces a comprehensive depiction of the patient’s health by combining data produced on the patient’s phone with data pulled from EHRs and other health institutions using the Fast Healthcare Interoperability Resources (FHIR) protocol. The unhindered access to this data encourages patient participation and keeps them up to speed on their test results, allergies, prescriptions, treatments, and other relevant information.
In this essay, we are going to talk about
- Discuss the three primary components of FHIR data models,
- Outline the two primary forms of FHIR implementation; and
- Provide a list of the difficulties and potential solutions associated with FHIR adoption.
FHIR COMPONENTS: RESOURCES, REFERENCES, PROFILES
The primary objective of FHIR is to provide a fundamental group of data components known as resources, which, when paired with one another through references, ought to cover the majority of clinical use cases. The extension method known as profiling provides support for additional situations that manifest themselves in certain health domains. The development of FHIR primarily focuses on the creation of these three components: resources, references, and profiles. Let’s go through each one of them.
The resources that are available to users are the fundamental component of the FHIR solutions. The majority of use cases in a clinical environment may be satisfied by using resources, which are informational packages that can be stored or exchanged.
As an example, a resource The term “patient” refers to the demographic and administrative information of a human or animal who is getting medical treatment. There are numerous of sites that address many elements of the healthcare industry, including patient management and scheduling, medical billing, and information tracking.
The data that will be communicated through this resource may be defined by the resource itself, and it can be expressed in a variety of forms (including UML, XML, and JSON). They could also include run-of-the-mill text with explanatory notes.
Check out the comprehensive resource index for additional information about the opportunities they provide. Utilizing references and profiles allows for even deeper customization of use cases for resources by developers.
It is uncommon to utilize a resource on its own, and the majority of resources include references to a variety of additional sources. You are able to create and customize certain situations by establishing a connection between Patient and Observation (which saves assertions made about a patient), Condition (problem or diagnosis), and Medication (ingredients, quantity, and strength of drugs). References may be found either in the form of a URL, an explicit identification, or in the description text itself.
The application of a resource is defined by a profile in accordance with certain conditions. Implementation Guides, which are also defined by FHIR, are used by developers to explain how their FHIR-based APIs may be used, and then they post these descriptions online.
One example is as follows: The Blue Button is a Fast Healthcare Interoperability Resources application programming interface (API) that facilitates data sharing for Medicare beneficiaries. Their Implementation Guide (IG) includes a listing of the profiles that correspond to the various use cases, such as “Carrier Claim Profile,” “Coverage Profile,” “Inpatient Profile,” and so on. You can check what components and value sets the resource needs to have in order to utilize a certain profile by looking under that profile’s heading.
Because this standardized procedure may be technically difficult but is necessary for interoperability compliance, it is important to note that there are tools and templates available for generating an Implementation Guide. There is an equal number of seminars and training courses available for IG creators as there are only for FHIR adopters.
One of the most difficult components of implementing FHIR is the process of profiling, which calls for an in-depth knowledge of both the FHIR resources available and the technical aspects of implementation. Therefore, in order to make interoperability easier to achieve, a tool that has built-in profiles was developed.
DIFFERENT KINDS OF FHIR IMPLEMENTATIONS
The FHIR standard was developed to accommodate a diverse range of potential use cases. Despite this, many firms will merely put in the bare minimum amount of work necessary to comply with the interoperability criteria and create an FHIR API. However, if a clinic wants to implement an enterprise-wide data management process and take advantage of analytical and decision support interfaces, it would need a more complicated architecture.
When it comes to developing an FHIR API, there are two possible options.
API of the FHIR standard layered on top of an existing system
It is possible that an EHR or other healthcare system will choose this path more often than any other. The implementation design may be broken down into approximately four layers: the first is a proprietary database, followed by a data access layer, then an FHIR adaptor or façade, and lastly the FHIR API.
Your system makes use of its own data model, which has to be transformed into FHIR resources in order to function as the layer that sits in front of an FHIR API. This conversion is carried out with the assistance of middleware developed by a third party and referred to as an FHIR adaptor or façade. The companies CureLogix and Firely both have products that are very popular.
System Native to the FHIR
This way is for people who are developing a new system and want it to be compatible with FHIR from the very beginning of the development process. This indicates that FHIR will be utilized in the architecture of the platform; resources, profiles, and extensions will be used to mandate the proprietary data model that can be used to develop a large number of interfaces and implementations that are compatible with one another.
Obviously, this strategy would be viable for a limited number of applications in particular.
For use in new product prototypes and development. By enabling healthcare startup companies to bypass the step of defining data and instead use data models that already exist, FHIR has the potential to streamline the process and establish a shortcut.
As an additional kind of storage. FHIR may also be used as a data storage mechanism if necessary. You don’t need to spend money on or spend time constructing an adaptor since you can easily save data in the format that you need. The same holds true for situations when you need somewhere to store data temporarily while an adaptor is being developed.
It is important to keep in mind that although the native approach will prevent your system from becoming obsolete and will prevent a significant number of errors that are caused by data translation, it is preferable to go native in collaboration with a technology partner.
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