Fast Healthcare Interoperability Resources (FHIR) is a healthcare data standard with an application programming interface (API) for representing and exchanging electronic health records (EHR). FHIR is an information network that lets you link data across systems and a communication network that lets you exchange data between systems.
FHIR includes the following:
- An HTTP-based RESTful protocol
- Data representation that uses JSON, XML, and RDF
For more details about FHIR, see the most recently published version of the FHIR specification.
Importance of FHIR in healthcare IT
It is often difficult to reconcile health information between healthcare IT systems because each healthcare IT system has historically used independent data models for their documents. As healthcare data becomes more digitized, this incompatibility becomes an expensive and time-consuming challenge.
FHIR addresses this issue by defining an open interoperability standard that has achieved widespread adoption. The FHIR standard is resource-based. Each resource in FHIR represents a discrete medical, administrative, infrastructural, or financial data element. Resources can be compiled and distributed to different healthcare providers in formats that comply with their respective data models.
With FHIR, resource definitions and REST APIs are published as a standard that accounts for most of their uses. This eliminates the need for healthcare providers to represent their data in proprietary data models. By default, FHIR both standardizes data through its core specification and offers flexibility for specific use cases.
Benefits of FHIR
Interoperability across devices and platforms
FHIR accommodates the exchange of healthcare data from monolithic data silos to open APIs. FHIR is the primary healthcare data standard with open APIs for accessing, searching, and modifying electronic health records (EHR) and exchanging data between healthcare IT systems.
FHIR lets EHR to be exchanged between healthcare providers and consumers on platforms such as the following:
- EHR-based data sharing
- Mobile apps
- Cloud-based applications
- Wearable devices
The FHIR API also lets third-party apps integrate with existing systems.
Compatibility with legacy standards
FHIR evolved from HL7 Version 2 messaging and HL7 Version 3 Clinical Document Architecture (HL7 CDA). FHIR can be used in partnership with HL7v2 and HL7 CDA.
For more information on the relationship between FHIR and other HL7 standards, see Appendix: The Relationship between FHIR and other HL7 Standards.
Decipherable and useful data
Because FHIR is implemented on top of the HTTPS protocol, you can retrieve and dissect FHIR resources to support machine learning, AI, and other forms of data analytics. These capabilities let you generate a deeper and more versatile understanding of your healthcare data.
Efficient data exchange
FHIR's resource-based approach facilitates more efficient and accurate data exchange. Because FHIR uses a uniform standard for health information, it lets you build custom templates from the shared base resources, and it eliminates inconsistency in data templates. This uniformity improves the accuracy and readability of data in data exchanges across health systems.
FHIR eliminates the need to individually modify the data template of every
health IT system by exchanging data as resources. FHIR exposes resources such as
patients, admissions, and medications as services. Therefore, consumer mobile
apps can use
POST requests to retrieve and manipulate only the
A FHIR store is a data store in the Cloud Healthcare API that holds FHIR resources. FHIR stores exist inside datasets.
resource provides a representation of a FHIR store's attributes. For each FHIR
store, you can choose options such as:
- Enabling the
updateCreatecapability (DSTU2, STU3, R4).
- Publishing changes to the FHIR store to a Pub/Sub topic.
- Requiring referential integrity.
- Enabling resource versioning (DSTU2, STU3, R4).
FHIR uses resources to organize data formats and elements. Each resource has the following properties:
- A shared method for defining and representing data, built upon data types consisting of reusable clusters of elements.
- A common set of metadata, providing technical and structural context.
- A human-readable text representation that uses HTML as a fallback display option for clinical safety.
FHIR specifies a base set of resources that can be combined in various ways to meet the data model demands of healthcare providers. It also provides representations of clinical observations and documents. FHIR does not aim to encompass every possible document or data type. Instead, FHIR first supports most clinical and billing use cases. You can then extend your FHIR implementation to meet additional clinical or organizational needs.
Using extensions, applications can customize the existing resources and describe their specifications with profiles. Profiles are a set of instructions in addition to the existing core specification for resources that fall under a specific use and context. The Cloud Healthcare API enforces profiles by validating resources against the constraints in the relevant profile.
For instance, recording a patient's ethnicity is not allowed in certain regions, but required in others. Using profiles, the FHIR base specification can define and require an "ethnicity" extension in accordance with the regional policies. Therefore, profiles help countries, regions, districts, and organizations customize data in accordance with their healthcare data regulations and needs.
You can use profiles to do the following:
- Extend and restrict the FHIR API by defining additional operations, specify required pre-existing search parameters, and add new search parameters.
- Extend and restrict resources by defining extensions of resources and changing the cardinality of fields.
A collection of profiles can be published as an implementation guide. Implementation guides are both machine- and human-readable. They can be exchanged and searched using REST and used to generate code and user interfaces.
For more information on FHIR extensions, see FHIR extensions.
FHIR base URL implementation
The Cloud Healthcare API uses a base URL that aligns with this standard. The Cloud Healthcare API base URL contains the following parts:
- The endpoint for the Cloud Healthcare API
- The version of the Cloud Healthcare API
- The project ID
- The name of a dataset
- The dataset's location
- The name of a FHIR store
The following table shows the format of a FHIR Service Base URL and its equivalent base URL in the Cloud Healthcare API:
|FHIR Service Base URL||Cloud Healthcare API equivalent URL|
To get information about a patient using the FHIR RESTful
API, make an HTTP
GET request. The following table shows the format to use to
get this information using the FHIR Service Base URL and its equivalent base URL
in the Cloud Healthcare API:
|FHIR Service Base URL||Cloud Healthcare API equivalent URL|
For more information on the FHIR DSTU2, STU3, and R4 implementations in the Cloud Healthcare API, see the FHIR conformance statement.
Integrating with OMOP
OMOP Common Data Model (OMOP CDM) is a standard developed by Observational Health Data Sciences and Informatics (OHDSI). It is primarily used for observational clinical data. The OHDSI tool suite can assist common analytics use cases such as cohort definition, cohort generation, and population effect estimation. It is a commonly used data model in genomics and pharmaceutical research due to its expansive terminology and genetics support.
See the following resources for more details about OMOP:
- OMOP common data model
- OMOP common data model and standardized vocabularies
- Getting started with OHDSI
By integrating FHIR and OMOP, clinical data from EHRs and other sources in the FHIR format can be used as research data in the OMOP standard. Specific fields and data elements in OMOP can also be integrated into existing data in FHIR.
You can use the open-sourced Cloud Healthcare API Data Harmonization mapping engine to perform the following tasks:
- Harmonizing data to the OMOP CDM and others.
- Configuring data mapping for FHIR-to-OMOP data conversion.