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How to Meet the New FHIR Interoperability Standards

Paul Kovalenko Paul Kovalenko | July 10, 2021 | 8 min

There are an estimated 4.1 million clinicians who use over 100 Electronic Health Records (EHR) systems for documenting care. Systems differ and data may be incorrect, inaccessible, or inadequately formatted. The concept of interoperability is meant to solve this problem as it aims at facilitating data exchange between different systems and institutions.

As the flow of clinical data is rapidly increasing, the global healthcare interoperability market is growing as well. It’s projected to reach $7.96 billion by 2024 demonstrating the 13.8% increase in comparison with 2019.

FHIR standards were introduced to enable data interoperability. In this article, we will discuss how to create communication using FHIR standards and why are they so important. 

What is FHIR?

FHIR (pronounced “fire”) stands for Fast Healthcare Interoperability Resources. It is both a standard for data formats and elements and an API for adequate exchange of Electronic Health Records. It was introduced by Health Level Seven International (HL7), a non-profit development organization whose main goal is to achieve maximum interoperability in the healthcare system on a global scale.

The draft version was published in February 2014, and the fourth iteration of a document (FHIR 4) that was created in October 2019 became a normative version.

The Centers for Medicare & Medicaid Services rolled out an interoperability mandate that enforces requirements on FHIR/HL7 usage. According to the FHIR mandate, health plans should meet the FHIR 4 standards by July 1, 2021, thus the interoperability standards became of ultimate importance for all players in the healthcare system.

FHIR Interoperability Standards


Why is FHIR Interoperability Important?

This interoperability standard is not another gruesome regulation that nobody needs. There are a variety of reasons that make the effort spent on interoperability worth it. The change is important for both healthcare institutions and patients.

First, interoperability is essential for the accessibility of EHRs across different healthcare institutions. If an institution with one EHR/EMR system tries to share the record with an institution with a different EHR provider, the data can alter to the point where it is not recognizable or readable to a human. Fast healthcare interoperability resources standards tackle this issue and allow free exchange between legacy systems as FHIR is built upon such previous clinical and administrative data specifications as HL7 v2, HL7 v3, and CDA.

Second, FHIR requirements allow patients to access their medical records. It will help them to better understand their conditions, make more informed decisions about their treatment, and become proactive about their health. They will also be able to make more informed decisions while choosing healthcare providers and easily transfer from one plan to another.

Thirdly, it allows the use of EHR/EMR systems on any device, from phones to desktops. Consequently, medical staff can easily access medical records whenever they need them and not rely on computers nearby.

In the meantime, HL7 promises that it is easy to implement the technology and takes a day to put up a simple functioning API. FHIR has the potential to promote innovations in healthcare technology, as it reduces the resources and time needed for healthcare software development as well as enables the ecosystem of interconnected solutions.

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How Can FHIR API-Based Data Exchange Support a Patient-Centered Approach to Care?

Technology helps a lot when it comes to patient-centered healthcare, from sparing personnel from administrative tasks to finding patients where they want to be found – online. Let’s take a look at how exactly HL7/FHIR APIs can help institutions increase the quality of healthcare services.

Data Accuracy

During data exchange without medical standard FHIR interoperability, it is likely that mistakes, and shifts in data will occur. Diameter Health revealed the fact that 80% of allergies aren’t coded correctly in EHR systems.

Such mistakes may result in wrong treatment which can be critical for the patients’ lives. Data accuracy provided by HL7’s FHIR standard will definitely help healthcare institutions avoid such events and save patients, money, and reputation.

Data Security

FHIR ensures secure data transfer due to a solid foundation of such web standards as XML, HTTP, Atom, OAuth, and JSON. These standardized data sets are also compatible with many security tools.

With API connectivity, healthcare providers will avoid manually filling in the information on different platforms which minimizes the risk of breach.

Data Analysis

It is either extra hard or impossible to analyze the data in different formats. When resources are standardized, entities may use Big Data to better understand the state of population health and, consequently, recognize crises earlier and handle them better. It is also a sufficient ground for scientific research.

Better Medical Applications

With APIs, integration of EHR/EMR in an application will become much easier. The quality and beneficialness of medical applications will increase while all aspects of an entity can be handled within one application: billing, staff schedules, ePrescriptions, drug control, etc.

Patients prefer institutions that utilize the power of technology to enable them to view lab results, and their prescriptions, create appointments, etc.

Less Billing Errors

If the data is transferred in the wrong way and any mistakes occur, it can affect the billing which is critical for healthcare facilities. One mistake will probably not cost much but mistakes tend to accumulate and skyrocket the costs of billing errors in the long run. According to statistics, billing mistakes cost hospitals $68 billion each year.

More Time for Patients

If medical personnel do not have to waste time figuring out the data transfer, sending and receiving faxes, and entering the same information into different systems, they will be able to connect more with patients and provide better services. Interoperability will also decrease the chances of burnout since people will manage work-life balance better as well.

Less Work for Patients

Patients will not have to fill out numerous paper forms every time they visit a hospital and they will also avoid explaining their situation over and over again to every doctor or nurse who does consultation or follow-up. Due to the current complicated data exchange, many physicians will either need extra time to fax the medical record or find a desktop to view it. It is easier to ask. Interoperability will allow different institutions to exchange data freely and gain access from anywhere.

How to Meet the FHIR Interoperability Standard – Main Requirements

Being an open organization, HL7 constantly shares actionable tips on how to easily meet the new FHIR interoperability standards. By registering at https://chat.fhir.org/login/ you can chat with the FHIR community, get answers to your questions and stay up to date with the recent news. Moreover, the community has already developed numerous open-source libraries and tools that you can use to your advantage.

HL7 claims that it’s not difficult to meet their requirements and that minimum help from the IT department is needed. If you wonder how to meet the FHIR standards, here are the main things to consider:

Patient-Access API Usage Provision

According to HL7 requirements, providers are obligated to implement a Patient-Access API that would facilitate quick access of healthcare plan enrollees to their data. Such information as health conditions, lab results, and prescribed treatment should be available to patients no later than one business day after the insurer receives it.

Providers have to include patient verification and access control to comply with FHIR internet security standards.

Provider Directory API Usage Provision

This type of HL7/FHIR API will allow third parties, especially medical applications, to view and change the data in medical records. It also needs security measures like access control to avoid data breaches.

This type of API also allows patients to see the listings of healthcare providers: name, address, phone numbers, and specialties at least. It will help patients choose the provider easily and wisely.

Admission, Discharge, and Transfer (ADT) Notifications Provision

Healthcare institutions have to send notifications when the patient is admitted, discharged, or transferred to another entity. The notification should include the patient’s name, treatment provider, and sending institution. An institution may not disclose the diagnosis.

It is supposed to facilitate information exchange between entities, identify patients who use healthcare services frequently, and avoid readmissions.

Information Blocking Provision

This provision was introduced mainly by the Office for National Coordination for Health Information (ONC). Healthcare institutions are not allowed to withhold information if an exception does not apply. Exceptions may be licenses, preventing harm, privacy, and security exceptions, fee exceptions, etc. However, healthcare institutions have to provide proof of exception. Otherwise, they will face a fine.

This step requires intensive medical staff training.

Payer-to-Payer Data Exchange Provision

Healthcare institutions have to exchange data freely as well so that patients can easily switch between hospitals, practices, etc. It will also standardize the data exchange across the industry and allow data analysis for public health control and scientific research.

API Functionality Provision

There must be two types of APIs: for single patients and a group of patients.

The first one is for patients who use medical applications and want to gain access to their data. The second one is for healthcare institutions that manage numerous patients at once and use multi-purpose applications for this.

It is one of the new FHIR standards and should be implemented by 2022.

See the timeline for the FHIR standards implementation below:

FHIR standards implementation


First Steps Towards Interoperability in Your Healthcare Organization

Some of the steps that healthcare facilities can already undertake to simplify the process of complying with FHIR standards in the future include the following activities:

  • Setting up and testing the FHIR Server
  • Receiving current data sources generating feeds for various data domains such as adjudication and labs
  • Converting feeds to FHIR standards by ingesting them into the mapping tool
  • Validating security for live hits through consuming apps as member portals and web-based platforms

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Now you know how to meet the FHIR health standard that opens room for better healthcare, adequate data exchange, and access to health data for patients. A healthcare provider needs to utilize different APIs and train medical staff on how to deal with Information Blocking.

Do you need assistance with API integration and ensuring full compliance with the FHIR new medical standard? Don’t hesitate to book a free consultation with the Langate team! Our professionals with more than 20 years of experience know everything about interoperability for healthcare and would be glad to discuss your project in detail.

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