FHIR (pronounced “fire”) might be the hottest topic in healthcare technology. EHRs have adopted it as the standard for sharing data with other systems and healthcare information exchanges (HIEs).
So what is FHIR, and what does the standard and technology promise for healthcare? This article breaks it down:
- What is the FHIR Standard?
- How Does FHIR Work?
- Who’s on FHIR?
- What is SMART on FHIR?
- What Can the FHIR Standard Do for Healthcare?
What is the FHIR Standard?
Fast Healthcare Interoperability Resources (FHIR) is an advanced, open-source standard for healthcare information exchange across EMRs and other systems.
Health Level Seven International, the standards bearer for healthcare interoperability, first released FHIR in 2014, building on decades of work with the HL7 standard. It quickly emerged as the most powerful and elegant way yet for healthcare systems to have meaningful conversations with each other.
Most EHRs have embraced these API standards for sharing data. Big players like Apple also rapidly adopted the FHIR interface standards and protocols, additionally boosting its momentum throughout healthcare. The 21st Century Cures Act and final rules from the Centers for Medicare and Medicaid Services (CMS) have since mandated the adoption of the standards by almost every healthcare organization. Payers in particular have pressure to adopt the standard and expand patient access to their health data by connecting and sharing with other systems.
If you’re in healthcare, you’re playing with FHIR.
How Does FHIR Work?
FHIR establishes a universal structure for data that allows any system to read and understand it, regardless of its origin. The standard uses modern web-based APIs to seamlessly integrate various applications into a central operating system, radically simplifying data flow within a provider’s workflow.
But first, let’s define a healthcare data interface. A data interface, or application programming interface (API), is software that lets two different systems talk to each other and share data. Imagine one healthcare system defines a “provider code” as a circle, while a second system defines it as a rectangle. An API acts as a translator, allowing both systems to exchange data and recognize that the circle and rectangle both represent the same provider code.
This is a simple example. Healthcare data exchange is infinitely more complex, with dozens of EHRs defining hundreds of data types differently. As EHR adoption grew, “interoperability” was a chaotic landscape of custom, system-to-system interfaces. There was no single standard.
In 1987, HL7 emerged as the first major standard designed to control this chaos, enabling different EHRs to finally share data using a common interface.
But older HL7 versions have limitations. They use outdated protocols with a steep learning curve for developers. Mapping data can strip it of its context, diminishing its usefulness. Most critically, older HL7 versions only work with structured data—information organized in rigid fields, like a spreadsheet. Yet, 80% of all healthcare data is unstructured, including scanned images and doctors’ notes. Without it, true interoperability is impossible.
How Does FHIR Support Patients and Providers?
The healthcare IoT sector is exploding, but tools to connect patient-generated health data (PGHD) with provider workflows have been lacking. FHIR changes this by using modern web APIs that allow patients and physicians to easily access and share health information from anywhere.
FHIR offers a powerful opportunity to blend EHR data with diverse PGHD sources like wearables and remote patient monitoring (RPM) devices. This gives providers streamlined access to invaluable insights. Apps built on a FHIR platform can analyze PGHD to offer users a concise overview of trends in chronic disease management, empowering proactive care.
Patients also gain a comprehensive view of their own data. Apple’s Health app, for example, leverages FHIR to aggregate patient data from different EHRs and facilities into a single, unified record. For providers, FHIR enables them to connect with third-party apps directly from their EHR, breaking free from system constraints. This allows for more efficient and economical app development with vendors, ensuring data consistency across all sources.
The Evolutionary Difference: How FHIR Is Transforming Healthcare Data
FHIR is the next-generation standard that solves these problems. It builds on HL7’s foundation but expands its capabilities in three critical ways:
- Solves Unstructured Data Exchange: FHIR allows systems to share both structured and unstructured data, closing the biggest interoperability gap and eliminating tedious manual work.
- Helps Build Interfaces Faster and Easier: FHIR embraces modern API technology, including the RESTful protocol and flexible data formats like JSON, XML, or RDF. Developers are familiar with these tools, making FHIR standards easier to learn and APIs easier to build.
- Introduces Resources to Make Better, More Intuitive Sense of Data: FHIR introduced the concept of “resources”—data categories representing common healthcare components like patients, lab results, and appointments. With 145 defined resources, this makes interfaces more flexible and data more recognizable and valuable to receiving systems.
Does FHIR Advance Semantic Interoperability?
HIMSS says that interoperability “describes the extent to which systems and devices can exchange data and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.”
HIMSS defines three technical tiers of interoperability: Foundational, structural, and semantic.
- Foundational Interoperability: One system can send data to another.
- Structural Interoperability: One system sends data that the other system understands.
- Semantic Interoperability: Systems can exchange, interpret, and actively use the data. This is what everyone in healthcare wants to achieve: sharing patient data across all systems that looks the same to everyone involved in the patient journey.
While great progress has been made, many organizations still operate in the first two tiers. FHIR has dramatically accelerated healthcare’s journey toward more useful semantic data sharing.
However, technologists caution that variations in how data is collected and coded prevent FHIR from achieving full semantic interoperability on its own. Other active technology efforts are underway to add this next layer of intelligence.
Who’s in for the change?
EHRs: The good news is that all major EHRs, including Epic, Cerner, Allscripts, and athenahealth, have established FHIR-based APIs. These players cover 83% of hospitals and 53% of clinicians. The foundation for interoperability is in place, though wider adoption remains a work in progress.
The Game Changers: Apple’s early adoption of SMART on FHIR to connect with EHRs was a breakthrough. Now, Walmart, Google, Amazon, and Microsoft are all pursuing FHIR-based solutions, poised to redefine patient-focused, data-driven experiences.
Payers: The 21st Century Cures Act mandates FHIR adoption for payers, requiring specific APIs for patient access, provider directories, and payer-to-payer communication.
Providers: Adoption is high but often limited to the FHIR APIs provided by their EHRs. Many hospitals have been slow to leverage the standard to improve other areas, like patient access. This creates a risk of being outpaced by tech giants in defining the modern patient experience.
What is SMART on FHIR?
MART on FHIR provides a universal, secure framework for applications to request, access, and use data. It combines the SMART (Substitutable Medical Applications and Reusable Technologies) open-source tools with the FHIR API, allowing developers to build a single app that works with any health information system.
SMART on FHIR apps let providers and patients view records, monitor health, and schedule services by pulling data from any EHR system, whether it’s Epic, Cerner, or another vendor. It defines how apps work with EHRs, which users are connected to, and what data they can retrieve.
The 21st Century Cures Act now mandates SMART certification, making SMART on FHIR app development a lasting part of healthcare’s future.
What Can FHIR Do for Healthcare?
By getting all healthcare systems to speak and understand the same language, the FHIR standard can:
- Make healthcare data exchange faster, more efficient, more accurate, and more useful than ever before
- Improve clinical point-of-care decisions and care coordination
- Give consumers and patients more access to their health information from all systems
- Amplify financial performance by adding precision and speed to the revenue cycle
This list of potential and real benefits for healthcare goes on and on. They add up to a Connected Care Experience for patients, doctors, nurses, care coordinators, lab techs, claims processors and billers, discharge planners, and everyone involved in the care journey. Let’s look at that vision:
The Future of FHIR
The promise and possibilities for the FHIR standard in healthcare have few bounds. Every health IT company, provider, and payer must have clear plans for interoperability to consume and use patient data meaningfully in their workflows.
Software companies, providers, and payers must seek the fastest, most reliable path to connect their systems and share data using the standard.
But building a FHIR interoperability strategy and interfaces within your own organization remains complex. Healthcare IT leaders acknowledge that they still have a lot to learn about where and how to take smart advantage of the standard.
FAQs
1. What is the FHIR standard?
In simple terms, the FHIR standard (Fast Healthcare Interoperability Resources) is a set of rules for how health data is structured and shared. It uses modern web technologies, so systems can exchange information quickly and safely.
2. Why does the FHIR standard matter for my organization?
The FHIR standard reduces custom interfaces and manual rework. It helps EHRs, labs, payers, and apps speak the same language, which lowers integration cost and speeds project timelines.
3. How does the FHIR standard represent data?
Data is organized into “Resources” like Patient, Observation, Medication, and Claim. Each resource has a clear schema and links to other resources, making the FHIR standard flexible for many workflows.
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