Healthcare systems worldwide are navigating a complex landscape, challenged by rising patient expectations, soaring operational costs, shortages of medical staff, strict compliance requirements, and the need to manage vast amounts of sensitive data. In this environment, digital transformation is essential to stop accepting what’s broken and start building what works.

A pivotal standard driving transformation in healthcare is Fast Healthcare Interoperability Resources (FHIR), designed to unlock the potential of health data. Below, we’ll explore what the FHIR protocol is, how it works, and how healthcare APIs can adopt FHIR for improved interoperability.

What Is the FHIR Protocol?

FHIR is a standard published by Health Level Seven International (HL7), a not-for-profit standards organization, developed for the electronic exchange of healthcare information. Its core purpose is to enable easy, fast, and flexible sharing of healthcare data across diverse systems, ensuring that patient information is consistently accessible, accurate, and up to date. FHIR aims to revolutionize how health information is exchanged, fostering seamless communication within the complex healthcare ecosystem.

How FHIR Works

FHIR’s design incorporates modern architectural principles to facilitate efficient and secure data exchange:

Modular Structure With Resources

FHIR utilizes a modular approach where “resources” are the fundamental building blocks of information. These resources represent common healthcare entities such as patients, medications, appointments, and lab results. These individual resources can be combined and extended to meet specific needs, providing both standardization and flexibility.

The FHIR specification itself is structured in levels, starting with a basic framework (Foundation, Implementer Support) and extending to real-world healthcare concepts like Administration, Clinical, Diagnostics, Medications, Workflow, and Financial data, as well as Clinical Reasoning and Medication Definition.

API-Based Approach With RESTful APIs

FHIR is deeply integrated with modern web technologies, primarily utilizing RESTful APIs for data exchange. This means data can be easily retrieved and updated over the web using standard HTTP requests. While FHIR does not strictly require HTTP, it is strongly implied as the preferred method, with individual actions mapped to HTTP verbs. FHIR outlines a set of standard interactions:

• Instance-Level Interactions: Reading (read, vread), updating (update, patch), deleting (delete), and retrieving history (history) for a specific resource instance.
• Type-Level Interactions: Creating new resources (create), searching resources of a specific type (search), conditional deletion (conditionalDelete), and history for a resource type.
• Whole-System Interactions: Retrieving server capabilities (capabilities), performing multiple operations in a single request (batch/transaction), and systemwide searching and history.

Main Features and Purposes of the FHIR Protocol

The core purpose of FHIR is to simplify, speed up, and make more flexible the electronic exchange of healthcare information, ultimately making patient data accessible, accurate, and up to date. This fundamental purpose is supported by its key features:

• Enables interoperability: FHIR is a key standard for interoperability, specifically engineered to facilitate seamless data exchange between diverse healthcare systems. It breaks down traditional data silos, supporting both simple data exchange (like patient demographics) and complex workflows (like care coordination). This directly helps hospitals enable interoperability as a key innovation area.
• Modern web-based foundation: By leveraging RESTful APIs and aligning with modern web technologies, FHIR makes it easier for developers to build and integrate healthcare applications, fostering innovation.
• Flexibility and extensibility: The protocol’s modular “resource” structure allows for customization to address specific requirements while maintaining a core set of common elements. This adaptability ensures it can be applied to a wide range of use cases.
• Robust security: Integrated security protocols are paramount for safeguarding sensitive patient data, ensuring compliance with healthcare regulations, and building patient trust.
• Open standard: FHIR is an open standard under a CC0 open license, promoting widespread adoption and collaborative development within the healthcare community.

Extending FHIR for Business Impact in the API World

FHIR’s design makes it a powerful enabler for digital transformation and innovation, directly impacting the business of healthcare systems and the broader healthcare industry. Its API-first nature allows for extensions and applications that drive business value in a few significant ways.

Modernizing Internal Workflows and Operational Efficiency

By enabling seamless communication between disparate systems, including major EMR/EHRs like Cerner, Epic, and Athena, FHIR increases operational efficiency, reduces manual effort, and minimizes errors. This directly addresses pressures like soaring operational costs and staff shortages. This is a key area for hospitals to innovate.

Digitizing Patient Journeys and Enhancing Patient Experience

FHIR facilitates the development of consumer-facing applications such as online appointment booking, patient support, digital check-ins, and comprehensive patient portals. This meets rising patient expectations for more accessible and digital healthcare experiences, improving satisfaction and engagement. Digitizing patient journeys is a crucial innovation for hospitals.

Enabling Personalized and Preventive Care Models

Enhanced access to comprehensive, accurate, and timely patient data through FHIR supports the development and delivery of personalized and preventive care models. This is crucial for meeting modern patient expectations, fostering better health outcomes, and attracting and retaining patients in a competitive market. Embracing personalized and preventive care is a key innovation area for hospitals.

Ensuring Robust Data Security and Compliance

The integrated security protocols like OAuth 2.0 and SMART on FHIR are vital for securely accessing and sharing sensitive patient data. This helps healthcare organizations comply with strict regulations (such as HIPAA in the US, GDPR in Europe, and LGPD in Brazil) and maintain patient trust and organizational reputation, mitigating significant challenges hospitals face. Investing in cybersecurity and privacy is a key innovation area for hospitals.

Accelerating Digital Transformation Across the Ecosystem

FHIR’s alignment with modern web technologies, its API-centric design, and support for formats like JSON, XML, and RDF make it a foundational tool for digital transformation across payers, providers, and related businesses. It empowers organizations to build innovative applications quickly, easily, and securely.

Practical Extensions and Tools in the API World

To extend FHIR’s capabilities in the API world, organizations can utilize various tools and approaches:

• FHIR connectors and API templates: Generic platforms can offer prebuilt connectors to EMR and EHR systems (like Cerner, Epic, Athena) and FHIR servers, as well as FHIR API templates that can be automatically generated from implementation guides. Developers can then customize these templates to align with specific business logic and expose them as standard FHIR APIs.
• Clinical decision support (CDS) templates: Tools can generate service templates for clinical decision support (CDS) services based on CDS hook definitions, including basic functionalities like validation and prefetch. This facilitates connecting with external decision support systems.
• Open-source libraries: Open-source libraries like HAPI FHIR for Java provide extensive documentation and test servers for implementing FHIR-compliant APIs, serving as a valuable resource for developers. The FHIR connector, for example, uses HAPI FHIR APIs to connect with a test server.
• Secure API management: Leveraging features like SMART on FHIR for authentication and authorization is critical for securing healthcare APIs that expose sensitive data. FHIR API guidelines outline concepts like HTTP verbs, status codes, search parameters, and error formats.
• Customization and extensibility: FHIR-compliant APIs can be further customized using the Capability Statement Resource, which defines the REST interactions available on a server and specifies operation definitions for endpoints. Servers are required to provide a Capability Statement. This allows for tailored solutions while maintaining compliance.

A Robust Protocol

In essence, FHIR’s capability to provide the “right data at the right time” can mean the difference between loss and hope in healthcare delivery.

By embracing and extending the FHIR protocol through modern API practices and dedicated tools, healthcare organizations can effectively break down data silos, streamline operations, enable innovative care delivery models, and ensure secure and compliant data handling, all of which are crucial for their sustainability and growth in the digital age.