Difference between revisions of "HL7 FHIR"

From Clinfowiki
Jump to: navigation, search
(Related Pages)
 
(22 intermediate revisions by 6 users not shown)
Line 1: Line 1:
 +
===What is FHIR?===
  
'''FHIR – A new standard in interoperability, prime for cloud-based applications'''
+
Fast Healthcare Interoperability Resources (FHIR) is an interoperability standard created by [[HL7]]. FHIR utilizes a more modular approach to inter-system messaging than previous HL7 standards versions.  These modules, termed "resources", allow implementations to be more flexible to changing system processes than the traditional HL7V2 or V3 standards. The initial version of FHIR was created in 2012 and has undergone multiple revisions to date. There is currently an implementation standard in the draft standard for trial use (DTSU) phase, and not yet fully approved. Balloting for the current DSTU is slated for April of 2015 with a projected release of DSTU 2 for July 2015. <ref name="dtsu2014">FHIR DTSU v. 1.1. (2014). Retrieved October 21, 2014 from  http://www.hl7.org/implement/standards/fhir/index.html</ref>
 +
Rather than using multi-element structured messages such at HL7v2, HL7v3, and [[CDA]] standards, FHIR uses application programming interfaces (APIs) to select specific elements vs. the entire message as in the older HL7 standards. These APIs utilize a "RESTful" architecture, designed for web applications<ref name="dtsu2014" /><ref name="mckenzie2013">Mckenzie, L. (2013, May 13)Introduction to FHIR. Retrieved October 20, 2014 from http://gforge.hl7.org/svn/fhir/trunk/presentations/2013-05%20Tutorials/Introduction%20to%20FHIR.pptx</ref>. REST stands for Representational State Transfer which allows for exchange of resources on an as needed basis, typically communicated via widely used HTTP or HTTPS protocols<ref name="restful2013">What exactly is RESTful programming? (2013, Jan 16). Retrieved October 23, 2014 from http://stackoverflow.com/questions/671118/what-exactly-is-restful-programming</ref>.
  
===What is FHIR?===
+
[[Trusted Exchange Framework and Common Agreement (TEFCA)]]
  
FHIR is an interoperability standard created by HL7.  FHIR stands for Fast Health Interoperable Resources and utilizes a more modular approach to interoperability than previous HL7 standards versions.  These modules are termed “Resources” and allow implementations to be more flexible to changing system processes than traditional V. 2 or 3 standards. The initial version of FHIR was created in 2012 and has undergone multiple revisions to date. There is currently an implementation standard but it is in the draft standard for trial use (DTSU) phase and not yet fully approved. Balloting for the current DSTU is slated for April of 2015 with a projected release of DSTU 2 for July of 2015. <ref name="first">FHIR DTSU v. 1.1. (2014). Retrieved October 21, 2014 from  http://www.hl7.org/implement/standards/fhir/index.html </ref>
 
Rather than using multi-element structured messages such at HL7 v. 2, 3, and CDA standards, FHIR uses application programming interfaces (API’s) that call for specific elements vs. the entire message as in the other HL7 standards. These APIs utilize a RESTful architecture that is specifically designed for web applications.<ref name="first">FHIR DTSU v. 1.1. (2014). Retrieved October 21, 2014 from  http://www.hl7.org/implement/standards/fhir/index.html </ref><ref name="second">Mckenzie, L. Introduction to FHIR. Retrieved October 20, 2014 from http://gforge.hl7.org/svn/fhir/trunk/presentations/2013-05 Tutorials/Introduction to FHIR.pptx</ref> REST stands for Representational State Transfer which allows for exchange of resources on an as needed basis, typically communicated via HTTP or HTTPS protocols.<ref name="third">What exactly is RESTful programming?. Retrieved October 23, 2014 from http://stackoverflow.com/questions/671118/what-exactly-is-restful-programming </ref>
 
 
===FHIR Governance===  
 
===FHIR Governance===  
  
FHIR is actually governed by three separate bodies within HL7. The FHIR Governance Board, appointed by the FHIR Technical Steering Committee provides the broad oversight of the standard. The FHIR Management Group, also appointed by the Technical Steering Committee, manage the day-to-day operations of the standard. Finally, he Modeling and Methodology Work Group handles the resource creation, guidelines and best practices.<ref name="fourth">FHIR Wiki. Retrieved October 23, 2014 from http://wiki.hl7.org/index.php?title=FHIR</ref>
+
FHIR is governed by three separate bodies within HL7. The FHIR Governance Board, appointed by the FHIR Technical Steering Committee, provides broad oversight of the standard. The FHIR Management Group, also appointed by the Technical Steering Committee, manages the day-to-day operations of the standard. Finally, the Modeling and Methodology Work Group handles the resource creation, guidelines, and best practices<ref name="hl7wiki">HL7. (2014, Oct 22) FHIR Wiki. Retrieved October 23, 2014 from http://wiki.hl7.org/index.php?title=FHIR</ref>.
 +
 
 
===Why FHIR?===
 
===Why FHIR?===
  
FHIR is HL7’s answer to the call for a new interoperability standard that could more easily be used on mobile and cloud-based applications and also speed the implementation process. These implementations can often be completed within a day or week vs. the traditional month or year-long implementation timeline.<ref name="first">FHIR DTSU v. 1.1. (2014). Retrieved October 21, 2014 from  http://www.hl7.org/implement/standards/fhir/index.html </ref> FHIR is a needed update to the HL7 v. 2 but much less disruptive to workflows than v. 3. 
+
FHIR is HL7's answer to the call for a new interoperability standard that could more easily be used on mobile and cloud-based applications, and also speed the implementation process. These implementations can often be completed within a day or week, versus the traditional month- or year-long implementation timeline<ref name="dtsu2014" />. FHIR is a needed update to HL7v2, but expected to be much less disruptive to workflows than HL7v3.
The specification is free and allows unrestricted use. FHIR uses the building-blocks of HL7 v. 2, 3 and CDA while improving the ease of use and flexibility to alter implementations as needed. The RESTful architecture is applied to web services to allow for easy transfer of resources between systems since they can be accessed through a uniform resource locator (URL). Due to this architecture, FHIR is well suited for mobile and cloud-based platforms.
+
 
The RESTful API architecture also allows for transfer of data from one system to another without a need for the receiving system to know the structure of the API itself. This simplifies the interface between systems. (3) Once called to the receiving system, these individual resources can be extended and adapted based on individual implementation needs.<ref name="first">FHIR DTSU v. 1.1. (2014). Retrieved October 21, 2014 from  http://www.hl7.org/implement/standards/fhir/index.html </ref>
+
The specification is free and allows unrestricted use. FHIR uses the building blocks of HL7v2, HL7v3, and [[CDA]] while improving the ease of use and flexibility to alter implementations as needed. The RESTful architecture is applied to web services to allow for easy transfer of resources between systems, since they can be accessed through a uniform resource locator (URL). Due to this architecture, FHIR is well suited for mobile and cloud-based platforms.
===The Fundamental Principles of FHIR===  
+
 
<ref name="fourth">FHIR Wiki. Retrieved October 23, 2014 from http://wiki.hl7.org/index.php?title=FHIR</ref>
+
The RESTful API architecture also allows for transfer of data between systems without requiring the receiving system to know the structure of the API itself. This simplifies the interface between systems. (3) Once called to the receiving system, these individual resources can be extended and adapted based on individual implementation needs<ref name="dtsu2014" />.
 
+
 
        1)      Prioritize implementation
+
===The FHIR Code===
        2) Provide a flexible framework for interoperability
+
From "Fundamental Principles of FHIR (aka The FHIR Code)"<ref name="fundprinc">Fundamental Principles of FHIR. (16 Sept 2014, 20:28). Retrieved 6 Dec 2015 from http://wiki.hl7.org/index.php?title=Fundamental_Principles_of_FHIR&oldid=90696</ref>.
        3) Keep complexity where it belongs
+
#Prioritize implementation
        4) Support but not mandate tight specifications
+
#Provide a flexible framework for interoperability
        5) Leverage open source development principles
+
#Keep complexity where it belongs
        6) Free to use
+
#Support but not mandate tight specifications
        7) Supports multiple exchange paradigms/architectures
+
#Leverage open source development principles
        8) Leverage common web technologies
+
#Free to use
        9) Forward and backward compatibility
+
#Supports multiple exchange paradigms/architectures
        10) Tooling requirements are mainstream and minimal
+
#Leverage common web technologies
 +
#Forward and backward compatibility
 +
#Tooling requirements are mainstream and minimal
 +
 
 
===FHIR Basics===
 
===FHIR Basics===
  
Resources are classified as either clinical, administrative, or infrastructural. These resources were developed out of the HL7 v.2 and v.3 (RIM) so these resources can coexist with previous HL7 standards. <ref name="first">FHIR DTSU v. 1.1. (2014). Retrieved October 21, 2014 from  http://www.hl7.org/implement/standards/fhir/index.html </ref> These resources are accessed via a URL via specific web calls.  Resources are represented in either XML or JSON format. These resources have a related profile that specifies the resource’s metadata, associated structures of the resource, and relevant extensions used in the structures. The metadata contains a resource ID, version ID and the last modified date, in addition to other information. This metadata allows resources to be searched efficiently. In addition, metadata contains tags that can link a specific resource to a workflow event.  This can be useful in establishing trigger events for initiating system interactions.   Finally, resources can also be referenced to one another, via a resource link, which can connect various data elements.
+
Resources are classified as either clinical, administrative, or infrastructural. These resources were developed from HL7v2 and from HL7v3's Reference Information Model (RIM); as such they are intended to coexist with previous HL7 standards<ref name="dtsu2014" />. Resources are accessed via web protocol calls to specific URLs, and represented using either [[XML]] or [[JSON]] format. Resources are exchanged and manipulated via PUT, GET, POST, and DELETE operations via individual APIs. Using these APIs, the resources can be queried by a receiving system or pushed from a host system.
Resources are exchanged and manipulated via PUT, GET, POST, and DELETE operations via the individual APIs.  Resources are queried by the receiving system or can be pushed from the host system.
+
 
 +
FHIR resources have related profiles to specify their metadata, associated structures, and relevant extensions used in those structures. Resource metadata includes resource ID, version ID, last modified date, and other information. Metadata can contain tags linking a specific resource to a workflow event; these tags can be used to trigger events that initiate system interactions. Metadata also allows for resources to be searched efficiently. Resources can also be referenced by one another using resource links, allowing for connection of various data elements.
 +
 
 
===Resource Classifications===
 
===Resource Classifications===
Individual resources are contained within one of three primary categories and then sub-classified within each category.<ref name="first">FHIR DTSU v. 1.1. (2014). Retrieved October 21, 2014 from  http://www.hl7.org/implement/standards/fhir/index.html </ref>
+
Individual resources are contained within one of three primary categories, then sub-classified within each category<ref name="dtsu2014" />:
 
   
 
   
      1) '''Clinical'''
+
# '''Clinical'''
              a. General
+
#* General
              b. Medications
+
#* Medications
              c. Diagnostic
+
#* Diagnostic
              d. Device Interactions
+
#* Device Interactions
      2) '''Administrative'''
+
# '''Administrative'''
              a. Attribution
+
#* Attribution
              b. Entities
+
#* Entities
              c. Workflow Management
+
#* Workflow Management
              d. Financial
+
#* Financial
      3) '''Infrastructural'''
+
# '''Infrastructural'''
              a. Support
+
#* Support
              b. Document Handling
+
#* Document Handling
              c. Exchange
+
#* Exchange
              d. Conformance
+
#* Conformance
 +
 
 
===FHIR enabled apps in use today===
 
===FHIR enabled apps in use today===
  
The Sustainable Medical Applications, reusable technologies (SMART) is a collaboration between the Harvard Medical School and the ONC. SMART sought to develop a platform for the rapid development of health applications that could run across multiple EHRs<ref name="fifth">Raths, D. (2014). "Trend: standards development. Catching FHIR. A new HL7 draft standard may boost web services development in healthcare." Healthcare Inform 31(2): 13, 16.</ref>They succeeded and now a variety of apps are “SMART-enabled”. The apps are used in clinical back-office settings, research, patient communication and patient facing applications.<ref name="sixth">SMART-Enabled HIT. Accessed October 23, 2014 from http://smartplatforms.org/smart-enabled-hit/ </ref>
+
[[SMART uses for public health|Sustainable Medical Applications, Reusable Technologies (SMART)]] is a collaboration between the Harvard Medical School and the Office of the National Coordinator for Health Information Technology ([[ONC]]). SMART sought to develop a platform for the rapid development of health applications that could run across multiple EHRs<ref name="raths2014">Raths, D. (2014). "Trend: standards development. Catching FHIR: A new HL7 draft standard may boost web services development in healthcare." Healthcare Inform 31(2): 13, 16.</ref>. They succeeded, and now a variety of apps are "SMART-enabled". The apps are used in clinical back-office settings, research, patient communication and patient facing applications<ref name="smart2014">SMART. (2014). SMART-Enabled HIT. Accessed October 23, 2014 from http://smartplatforms.org/smart-enabled-hit/</ref>.
FHIR is also gaining support in the U.K. Nearly ten apps have already been developed for use in various setting. Additionally, an alliance with the UK Renal Data Collaboration is planned.
+
 
 +
FHIR is also gaining support in the U.K. Nearly ten apps have already been developed for use in various setting. Additionally, an alliance with the UK Renal Data Collaboration is planned.
 +
 
 +
==Related Pages==
 +
* Review of Bender, D., & Sartipi, K. (2013, June). [[HL7 FHIR: An Agile and RESTful approach to healthcare information exchange]]. In 2013 IEEE 26th International Symposium on Computer-Based Medical Systems (CBMS) (pp. 326-331). IEEE.
 +
* Review of Kasthurirathne, S., Mamlin, B., Kumara, H., Grieve, G., & Biondich, P. (2015). [[Enabling Better Interoperability for HealthCare: Lessons in Developing a Standards Based Application Programing Interface for Electronic Medical Record Systems]]. J Med Syst Journal of Medical Systems, 39(182).
 +
* Review of Smits, M., Kramer, E., Harthoorn, M., & Cornet, R. (2015). [[A comparison of two Detailed Clinical Model representations: FHIR and CDA]]. ''European Journal for Biomedical Informatics, 11''(2), 7-17.
  
 
===References===
 
===References===
 
<references/>
 
<references/>
 
Submitted by (Chris Hoekstra)
 
  
 
[[Category:BMI512-FALL-14]]
 
[[Category:BMI512-FALL-14]]
 +
[[Category:Interoperability]]

Latest revision as of 18:44, 21 October 2019

What is FHIR?

Fast Healthcare Interoperability Resources (FHIR) is an interoperability standard created by HL7. FHIR utilizes a more modular approach to inter-system messaging than previous HL7 standards versions. These modules, termed "resources", allow implementations to be more flexible to changing system processes than the traditional HL7V2 or V3 standards. The initial version of FHIR was created in 2012 and has undergone multiple revisions to date. There is currently an implementation standard in the draft standard for trial use (DTSU) phase, and not yet fully approved. Balloting for the current DSTU is slated for April of 2015 with a projected release of DSTU 2 for July 2015. [1] Rather than using multi-element structured messages such at HL7v2, HL7v3, and CDA standards, FHIR uses application programming interfaces (APIs) to select specific elements vs. the entire message as in the older HL7 standards. These APIs utilize a "RESTful" architecture, designed for web applications[1][2]. REST stands for Representational State Transfer which allows for exchange of resources on an as needed basis, typically communicated via widely used HTTP or HTTPS protocols[3].

Trusted Exchange Framework and Common Agreement (TEFCA)

FHIR Governance

FHIR is governed by three separate bodies within HL7. The FHIR Governance Board, appointed by the FHIR Technical Steering Committee, provides broad oversight of the standard. The FHIR Management Group, also appointed by the Technical Steering Committee, manages the day-to-day operations of the standard. Finally, the Modeling and Methodology Work Group handles the resource creation, guidelines, and best practices[4].

Why FHIR?

FHIR is HL7's answer to the call for a new interoperability standard that could more easily be used on mobile and cloud-based applications, and also speed the implementation process. These implementations can often be completed within a day or week, versus the traditional month- or year-long implementation timeline[1]. FHIR is a needed update to HL7v2, but expected to be much less disruptive to workflows than HL7v3.

The specification is free and allows unrestricted use. FHIR uses the building blocks of HL7v2, HL7v3, and CDA while improving the ease of use and flexibility to alter implementations as needed. The RESTful architecture is applied to web services to allow for easy transfer of resources between systems, since they can be accessed through a uniform resource locator (URL). Due to this architecture, FHIR is well suited for mobile and cloud-based platforms.

The RESTful API architecture also allows for transfer of data between systems without requiring the receiving system to know the structure of the API itself. This simplifies the interface between systems. (3) Once called to the receiving system, these individual resources can be extended and adapted based on individual implementation needs[1].

The FHIR Code

From "Fundamental Principles of FHIR (aka The FHIR Code)"[5].

  1. Prioritize implementation
  2. Provide a flexible framework for interoperability
  3. Keep complexity where it belongs
  4. Support but not mandate tight specifications
  5. Leverage open source development principles
  6. Free to use
  7. Supports multiple exchange paradigms/architectures
  8. Leverage common web technologies
  9. Forward and backward compatibility
  10. Tooling requirements are mainstream and minimal

FHIR Basics

Resources are classified as either clinical, administrative, or infrastructural. These resources were developed from HL7v2 and from HL7v3's Reference Information Model (RIM); as such they are intended to coexist with previous HL7 standards[1]. Resources are accessed via web protocol calls to specific URLs, and represented using either XML or JSON format. Resources are exchanged and manipulated via PUT, GET, POST, and DELETE operations via individual APIs. Using these APIs, the resources can be queried by a receiving system or pushed from a host system.

FHIR resources have related profiles to specify their metadata, associated structures, and relevant extensions used in those structures. Resource metadata includes resource ID, version ID, last modified date, and other information. Metadata can contain tags linking a specific resource to a workflow event; these tags can be used to trigger events that initiate system interactions. Metadata also allows for resources to be searched efficiently. Resources can also be referenced by one another using resource links, allowing for connection of various data elements.

Resource Classifications

Individual resources are contained within one of three primary categories, then sub-classified within each category[1]:

  1. Clinical
    • General
    • Medications
    • Diagnostic
    • Device Interactions
  2. Administrative
    • Attribution
    • Entities
    • Workflow Management
    • Financial
  3. Infrastructural
    • Support
    • Document Handling
    • Exchange
    • Conformance

FHIR enabled apps in use today

Sustainable Medical Applications, Reusable Technologies (SMART) is a collaboration between the Harvard Medical School and the Office of the National Coordinator for Health Information Technology (ONC). SMART sought to develop a platform for the rapid development of health applications that could run across multiple EHRs[6]. They succeeded, and now a variety of apps are "SMART-enabled". The apps are used in clinical back-office settings, research, patient communication and patient facing applications[7].

FHIR is also gaining support in the U.K. Nearly ten apps have already been developed for use in various setting. Additionally, an alliance with the UK Renal Data Collaboration is planned.

Related Pages

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 FHIR DTSU v. 1.1. (2014). Retrieved October 21, 2014 from http://www.hl7.org/implement/standards/fhir/index.html
  2. Mckenzie, L. (2013, May 13)Introduction to FHIR. Retrieved October 20, 2014 from http://gforge.hl7.org/svn/fhir/trunk/presentations/2013-05%20Tutorials/Introduction%20to%20FHIR.pptx
  3. What exactly is RESTful programming? (2013, Jan 16). Retrieved October 23, 2014 from http://stackoverflow.com/questions/671118/what-exactly-is-restful-programming
  4. HL7. (2014, Oct 22) FHIR Wiki. Retrieved October 23, 2014 from http://wiki.hl7.org/index.php?title=FHIR
  5. Fundamental Principles of FHIR. (16 Sept 2014, 20:28). Retrieved 6 Dec 2015 from http://wiki.hl7.org/index.php?title=Fundamental_Principles_of_FHIR&oldid=90696
  6. Raths, D. (2014). "Trend: standards development. Catching FHIR: A new HL7 draft standard may boost web services development in healthcare." Healthcare Inform 31(2): 13, 16.
  7. SMART. (2014). SMART-Enabled HIT. Accessed October 23, 2014 from http://smartplatforms.org/smart-enabled-hit/