Fast Healthcare Interoperability Resources (FHIR®) from Health Level Seven (HL7) is making waves across the healthcare industry. In fact, EHR vendors including Cerner, Epic and Meditech are quickly embracing the next-generation framework for its potential to advance data mobility and interoperability.
While still under development, the FHIR framework leverages the latest web standards and applies a tight focus on implementation, while also offering significant flexibility. In terms of more meaningful exchange of information, FHIR will provide the infrastructure to make data:
- Available easily on demand
- Retrievable across disparate EMR and other HIT applications
- Understandable using common healthcare language
FHIR stands to vastly improve the complexities associated with HL7 v3 Clinical Document Architecture (CDA)—the latest release characterized by high-entry barriers, low adoption, and an inability to keep up with market demand. Broad and abstract, the data elements of HL7 v3 are very precise by default, creating limitations to exchanging data in a way that is meaningful for care delivery. Further, the model is built upon document-centric data exchange, requiring time-consuming parsing of lengthy, computer-generated files to retrieve specific data.
In contrast, FHIR uses a RESTful API structure, built with modern internet conventions that support versatility of use. By creating plug-ins for EHRs without the need for interfaces, the standard promotes exchange and use of data through mobile devices, web-based applications, and cloud communications. It also supports better retrieval and exchange of discrete data elements from EHRs, which better positions healthcare organizations for population health and analytics initiatives. For instance, a patient medication list can be easily retrieved via FHIR to support drug-drug interaction checks within a clinical decision-support application.
FHIR and Terminology Management
In terms of best practices with terminology management, HL7 suggests the existence of an external terminology server working in tandem with FHIR as a resource. In essence, the standard needs to be able to reference a single source of truth for such concepts as code systems, value sets, and maps between standards. Like its predecessors such as the CDA and HL7, FHIR needs common terminology standards to achieve true semantic interoperability. For example, Code Systems Structured vocabularies and classification systems such as ICD-10, LOINC®, and SNOMED CT are best maintained within a dedicated terminology server as opposed to residing in FHIR itself. This way, data can be maintained and updated automatically as the new revisions of standards are released.
Value sets are definitions including codes from one or more code systems. Used to constrain values to populate FHIR resources within a given context, these systems tend to change over time. As such, it is a good idea to expand (or dump out the concepts contained within) value sets or validate (check to see if a given concept or concepts are members of a given value set) concept membership from a trusted source of truth via a terminology server like Health Language’s LEAP Code Group Manager.
Linking concepts to one another via maps has a number of important use cases, from data normalization to problem list refinement. A terminology server can effectively direct a system from a source concept to other targets. Specifically, FHIR specifies a resource called ConceptMap for traversing maps, which is best supported through the robust governance and cross-functional, collaborative workflow tooling of a terminology server such as Health Language’s LEAP Map Manager.
As the Meaningful Use programs transition to the more comprehensive MIPS payment structure, interoperability will be front and center for healthcare. FHIR represents a step in the direction towards improving this interoperability, and Health Language continues to be in the forefront.