What Are HL7 and FHIR Standards?

The FHIR data model is a standard for defining resources and associated metadata, such as clinical content and other pertinent system information such as the EHRs capabilities in a consistent, structured yet flexible modular format.

One of the terms most heard by those working in the field of health information technology is the HL7 FHIR (Fast Healthcare Interoperability Resources) standard. So what are the definitions of these two concepts and what are they used for? The FHIR standard regulates how information can be exchanged between different computer systems, regardless of how health information is stored in the systems. This standard ensures that health information, including clinical and administrative information, is safely accessible to those who have permission and need access to this information to benefit the care the patient receives. The standard development organization HL7 (Health Level 7) adopts a collaborative approach to develop and update FHIR.

The development process of FHIR started in 2012 to respond to market needs by providing faster, easier, and better methods to share rapidly growing health information. Historically, patient records were siloed in the practitioner’s office, due to paper-based documentation. The fax machine changed how patient data could be shared, but as new forms of communication came online, they were often not viable solutions due to different regulations and standards e.g. HIPAA.

With the emergence of electronic health record systems (EHRs), direct system-to-system secure digital transfer and portability of patient records become possible. Yet, at the beginning of 2020, we still see data formatting and availability as the wild, wild west. Each system implementer provides different ways to share data, or in some cases, prevent the sharing of data.

In 1987, Health Level Seven International’s (HL7) formed as a non-profit to help define data portability within the Industry. Over time, HL7 became a leader in defining standards for data sharing and interoperability. Since HL7’s founding, they have provided a variety of data portability formats and standards. These formats have evolved over the years to meet the needs of data providers and consumers, with varying success and often limitations.

Initial formats (e.g. HL7 v2 & 3), which were great starts in data interoperability, have proved to be either too unstructured or too limited in scope to be useful for all clinical applications. To work around these limitations, many vendors created their own data formats and Application Programming Interface (API) standards to enable data sharing.

Since there was no mandated universal standard for data exchange, format and integration fragmentation put a lot of pressure on vendor integration teams. Each EHR system has its own data formats (often a hybrid approach using some industry standards and their own custom formats). This required the integration team to create custom implementations for each platform they wished to integrate with. Because every implementation required a time and monetary investment, this meant that the APIs intended to provide data portability, ironically became hurdles for larger integration strategies.

HL7’s newest standard is Fast Healthcare Interoperability Resources (HL7 FHIR, pronounced HL7 “fire”). The goal of the FHIR data model, according to HL7, is to help ease the challenges of data sharing and interoperability by simplifying implementation without sacrificing information integrity. It leverages existing logical and theoretical models to provide a consistent, easy to implement, and rigorous mechanism for exchanging data between healthcare applications.

The newest release of FHIR HL7 (version 4.0) is the first normative release of the FHIR standard. This is a crucial milestone for FHIR HL7 and the future of clinical interoperability in healthcare because any future changes to the specification need to be backward compatible with the base normative version. This helps guarantee vendors that their implementations will not deteriorate over time or require rewriting as new versions of the Fast Healthcare Interoperability Resources format are released.

Advantages of FHIR Standard to Software Developers

• A strong focus on fast and easy implementation; developers have reported they experienced simple interfaces being implementable in a single day.

• Free to use with no restrictions.

• Support from major vendors including Apple, Microsoft, Google, Epic, Cerner, and most other EHR vendors.

• Many free, online, and downloadable tools, including reference servers and implementation libraries.

• Many public examples available to help kick-start development of new applications.

• Interoperability out-of-the-box – base resources can be used as is, but can also be adapted for local requirements (the process of Profiling).

• An evolutionary development path from earlier HL7 healthcare standards, Version 2 and Clinical Document Architecture (CDA®), enabling them to co-exist and leverage each other.

• A strong foundation in web standards including XML, JSON, HTTP, and OAuth.

• Concise and easily-understood online specifications.

• A human-readable serialization format for ease of use by developers.

• A global community to assist implementers.

In addition, you can get detailed information about HL7 and FHIR Standard by reading our article titled How to Make Telehealth Safer and More Effective See you on different topics.