What is FHIR?

FHIR is the abbreviation for Fast Healthcare Interoperability Resources. It provides a standard to exchange electronic healthcare records by defining data formats and resources. 

Who created the FHIR Standard?

This FHIR standard was created by the Health Level Seven International (HL7) health-care standards organization. It is a non-profit, ANSI-accredited standard developing organization. It provides comprehensive frameworks and related standards for

• Exchange
• Integration
• Share
• Retrieval

of electronic health information that supports for management, delivery and evaluation of health services.

Why FHIR?

This FHIR Standard allows healthcare application developers to build standardized web applications without worrying about its underlying Electronic Health Record(EHR) System that used to get health records. 

It has the potential to be the communication language between all kinds of different healthcare apps and services like fitness trackers, personal health apps, clinical labs and many more.

FHIR is built using previous data formats like HL7 version 2.x and HL7 version 3.x. But FHIR uses followings to make the implementation easier.

• HTTP-based RESTful protocol for data transfer.
• HTML and CSS for user interface integration.
• JSON, XML or RDF for data representation.

All the application which use FHIR standard will give the same format data representation for Electronic Health Records.

How FHIR work?

Followings are some of the healthcare domain entities.

• Patient
• Practitioner
• Person
• Medication

FHIR standard has a set of resources that model these kinds of healthcare domain entities. So Patient is one the resources in the FHIR standard. Also, these resources have sub-resources like name and address. This standard builds one resource by adding several sub-resources.

HAPI FHIR Testing console provides a nearly complete implementation of the FHIR Specification. You can check how it is from here.

Format of the FHIR Patient Resource 

{

"resourceType" : "Patient",

// from Resource: id, meta, implicitRules, and language

// from DomainResource: text, contained, extension, and modifierExtension

"identifier" : [{ Identifier }], // An identifier for this patient

"active" : <boolean>, // Whether this patient's record is in active use

"name" : [{ HumanName }], // A name associated with the patient

"telecom" : [{ ContactPoint }], // A contact detail for the individual

"gender" : "<code>", // male | female | other | unknown

"birthDate" : "<date>", // The date of birth for the individual

// deceased[x]: Indicates if the individual is deceased or not. One of these 2:

"deceasedBoolean" : <boolean>,

"deceasedDateTime" : "<dateTime>",

"address" : [{ Address }], // An address for the individual

"maritalStatus" : { CodeableConcept }, // Marital (civil) status of a patient

// multipleBirth[x]: Whether the patient is part of a multiple births. One of these 2:

"multipleBirthBoolean" : <boolean>,

"multipleBirthInteger" : <integer>,

"photo" : [{ Attachment }], // Image of the patient

"contact" : [{ // A contact party (e.g. guardian, partner, friend) for the patient

"relationship" : [{ CodeableConcept }], // The kind of relationship

"name" : { HumanName }, // A name associated with the contact person

"telecom" : [{ ContactPoint }], // A contact detail for the person

"address" : { Address }, // Address for the contact person

"gender" : "<code>", // male | female | other | unknown

"organization" : { Reference(Organization) }, // C? Organization that is associated with the contact

"period" : { Period } // The period during which this contact person or organization is valid to be contacted relating to this patient

}],

"communication" : [{ // A language which may be used to communicate with the patient about his or her health

"language" : { CodeableConcept }, // R! The language which can be used to communicate with the patient about his or her health

"preferred" : <boolean> // Language preference indicator

}],

"generalPractitioner" : [{ Reference(Organization|Practitioner|

PractitionerRole) }], // Patient's nominated primary care provider

"managingOrganization" : { Reference(Organization) }, // Organization that is the custodian of the patient record

"link" : [{ // Link to another patient resource that concerns the same actual person

"other" : { Reference(Patient|RelatedPerson) }, // R! The other patient or related person resource that the link refers to

"type" : "<code>" // R! replaced-by | replaces | refer | seealso

}]

}

source - http://hl7.org/fhir/patient.html

Who uses FHIR?

• Apple uses the FHIR standard inside the iPhone to make the connection between the electronic health record (EHR) and a user’s Health app.
• Google Cloud Healthcare API uses an FHIR Store to store data as FHIR resources.
• Azure provides API to easily create and deploy an FHIR service for health data solutions.
• AWS can extract an unstructured text, process it using Amazon Comprehend Medical and then map it into FHIR resource.

FHIR is not 

• A complete data model for healthcare Records.
• Highly restrictive.
• A Security specification.
• A software.
• Fully backwards compatible.
• A Mechanism to use EHR across diverse care settings and clinical softwares (semantic interoperability)